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Sample records for veterans medical center

  1. Distance to Veterans Administration Medical Centers as a Barrier to Specialty Care for Homeless Women Veterans.

    Science.gov (United States)

    Gawron, Lori M; Pettey, Warren B P; Redd, Andrew M; Suo, Ying; Gundlapalli, Adi V

    2017-01-01

    Homeless women Veterans have a high prevalence of chronic mental and physical conditions that necessitate frequent healthcare visits, but travel burdens to specialty services may be overwhelming to navigate for this population, especially for those in rural settings. Access to specialty care is a key priority in the Veterans Health Administration (VHA) and understanding the geographic distribution and rural designation of this population in relation to medical centers (VAMC) can assist in care coordination. We identified 41,747 women Veterans age 18-44y with administrative evidence of homelessness in the VHA anytime during 2002-2015. We found 7% live in rural settings and 29% live >40miles from a VAMC. The mean travel distance for homeless women Veterans with a rural designation to a VAMC specialty center was 107 miles. Developing interventions to overcome this travel burden and engage vulnerable Veterans in necessary care can improve overall health outcomes for this high-risk population.

  2. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Grants for the..., Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants to the Republic of the Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center...

  3. A Health Assessment Survey of Veteran Students: Utilizing a Community College-Veterans Affairs Medical Center Partnership.

    Science.gov (United States)

    Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Sehgal, Ashwini R; Aron, David C

    2015-10-01

    To assess health status among student veterans at a community college utilizing a partnership between a Veterans Affairs Medical Center and a community college. Student veterans at Cuyahoga Community College in Cleveland, Ohio, in January to April 2013. A health assessment survey was sent to 978 veteran students. Descriptive analyses to assess prevalence of clinical diagnoses and health behaviors were performed. Logistic regression analyses were performed to assess for independent predictors of functional limitations. 204 students participated in the survey (21% response rate). Self-reported depression and unhealthy behaviors were high. Physical and emotional limitations (45% and 35%, respectively), and pain interfering with work (42%) were reported. Logistic regression analyses confirmed the independent association of self-reported depression with functional limitation (odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.4-7.8, p student veterans at a community college. A partnership between a Veterans Affairs Medical Center and a community college can be utilized to help understand the health needs of veteran students. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  4. Adaptation of Lean Six Sigma Methodologies for the Evaluation of Veterans Choice Program at 3 Urban Veterans Affairs Medical Centers.

    Science.gov (United States)

    Ball, Sherry L; Stevenson, Lauren D; Ladebue, Amy C; McCreight, Marina S; Lawrence, Emily C; Oestreich, Taryn; Lambert-Kerzner, Anne C

    2017-07-01

    The Veterans Health Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers. LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers. LSS techniques were used to assess data obtained through semistructured interviews with Veterans, staff, and providers to describe and evaluate the VCP process by identifying wastes and defects. The LSS methodology facilitated the process of targeting priorities for improvement and constructing suggestions to close identified gaps and inefficiencies. Identified key process wastes included inefficient exchange of clinical information between stakeholders in and outside of the VHA; poor dissemination of VCP programmatic information; shortages of VCP-participating providers; duplication of appointments; declines in care coordination; and lack of program adaptability to local processes. Recommendations for improvement were formulated using LSS. This evaluation illustrates how LSS can be utilized to assess a nationally mandated health care program. By focusing on stakeholder, staff, and Veteran perspectives, process defects in the VCP were identified and improvement recommendations were made. However, the current LSS language used is not intuitive in health care and similar applications of LSS may consider using new language and goals adapted specifically for health care.

  5. Conflict of interest issues pertinent to Veterans Affairs Medical Centers.

    Science.gov (United States)

    Hanna, Jennifer; Simiele, Ernest; Lawson, D Curtis; Tyler, Douglas

    2011-09-01

    Conflicts of interest exist when an arrangement potentially exerts inappropriate influence on decision making or professional judgment, or is perceived to do so, and can thus damage the public trust and undermine the integrity of those decisions. Concerns regarding financial conflicts of interest in the medical arena have reached their height as of late, given that physicians now function in a milieu of complex and delicate relationships with pharmaceutical, biotechnology, and medical device industries. Even when such relationships do not correlate with actual compromise of judgment or patient care, it threatens the credibility of both the health care professional and the institution because of the social perception of the effect of these relationships. Although most institutions in the Western world set forth a code of ethics and conflict-of-interest policies to be followed under threat of termination, the Veterans Health Administration (VHA) presents itself as a unique environment in which conflicts of interest are subject to governmental laws, violation of which may not only result in employment-related discipline, but may be sanctioned by civil and criminal penalties. Moreover, these provisions are developed by a national authoritative organization rather than being institution-specific guidelines. Given that many academic physicians working within the VHA may also have a component of their practice in a University setting, it becomes important to understand the differences in policy between these contexts so as not to threaten the public trust in the veracity of decisions made and, therefore, maintain the integrity of the relationship between physician and patient. This article will review aspects of conflict-of-interest policies in the realm of research, financial relationships, foreign travel, and vendor contracting that are particular to the VHA and make it a unique environment to function in as a physician and scientist. Copyright © 2011 Society for

  6. Racial And Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes.

    Science.gov (United States)

    Washington, Donna L; Steers, W Neil; Huynh, Alexis K; Frayne, Susan M; Uchendu, Uchenna S; Riopelle, Deborah; Yano, Elizabeth M; Saechao, Fay S; Hoggatt, Katherine J

    2017-06-01

    Patient-centered medical homes are widely promoted as a primary care delivery model that achieves better patient outcomes. It is unknown if their benefits extend equally to all racial/ethnic groups. In 2010 the Veterans Health Administration, part of the Department of Veterans Affairs (VA), began implementing patient-centered medical homes nationwide. In 2009 significant disparities in hypertension or diabetes control were present for most racial/ethnic groups, compared with whites. In 2014 hypertension disparities were similar for blacks, had become smaller but remained significant for Hispanics, and were no longer significant for multiracial veterans, whereas disparities had become significant for American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders. By contrast, in 2014 diabetes disparities were similar for American Indians/Alaska Natives, blacks, and Hispanics, and were no longer significant for Native Hawaiians/other Pacific Islanders. We found that the modest benefits of the VA's implementation of patient-centered medical homes were offset by competing multifactorial external, health system, provider, and patient factors, such as increased patient volume. To promote health equity, health care innovations such as patient-centered medical homes should incorporate tailored strategies that account for determinants of racial/ethnic variations. Evaluations of patient-centered medical homes should monitor outcomes for racial/ethnic groups. Project HOPE—The People-to-People Health Foundation, Inc.

  7. The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight

    Science.gov (United States)

    2013-09-18

    E M B E R 1 8 , 2 0 1 3 The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More...Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight 5a. CONTRACT NUMBER...Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight Objective Our audit objective was to determine whether the

  8. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

    Science.gov (United States)

    Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.

    2016-01-01

    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

  9. Open access in the patient-centered medical home: lessons from the Veterans Health Administration.

    Science.gov (United States)

    True, Gala; Butler, Anneliese E; Lamparska, Bozena G; Lempa, Michele L; Shea, Judy A; Asch, David A; Werner, Rachel M

    2013-04-01

    The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.

  10. Trabeculectomy Outcomes by Supervised Trainees in a Veterans Affairs Medical Center.

    Science.gov (United States)

    Biggerstaff, Kristin S; Vincent, Ryan D; Lin, Albert P; Orengo-Nania, Silvia; Frankfort, Benjamin J

    2016-08-01

    To evaluate the outcomes of trabeculectomy performed in an ophthalmology training program. Retrospective study. A total of 160 patients undergoing trabeculectomy performed by a resident or fellow under attending supervision. Trabeculectomy surgeries performed by a supervised resident or fellow surgeon between October 2000 and April 2010 were reviewed. Success was considered to be complete or partial if intraocular pressure (IOP)-lowering medications were not or were required to achieve IOP≤21 mm Hg, respectively. Failure was defined as IOP>21 mm Hg on 2 consecutive visits, loss of light perception vision, IOP≤5 on 2 consecutive visits with associated visual acuity loss of ≥2 lines, or need for surgical intervention. Trabeculectomy survival was determined using Kaplan-Meier analysis through 60 months of follow-up. Final IOP, success/failure rate. Complete success was achieved in 65 patients (41%). The average final IOP of this group was 9.1±3.7 mm Hg. Qualified success was achieved in 56 patients (35%). The average final IOP of this group was 11.5±6.4 mm Hg. At 60 months, the estimated cumulative probability of survival for complete and qualified successes was 28.9% and 63.7%, respectively. Among patients undergoing trabeculectomy by supervised residents or glaucoma fellows in a large Veterans Affairs Medical Center, IOP reduction was significant and similar to published studies. Trabeculectomy remains a successful intervention to lower IOP, with satisfactory success rates in the hands of trainee surgeons.

  11. Health Hazard Evaluation Report HETA 91-395-2244, Veterans Administration Medical Center, Los Angeles, California

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    Kelly, J.E.; Miller, A.

    1992-08-01

    In response to a request from an employee of the Veterans Administration Medical Center (SIC-8062), Los Angeles, California, an investigation was undertaken of exposures to chemicals in the laboratory department, excessive heat and humidity in the kitchen area of the dietetics department, and carbon-monoxide (630080) exposures inside the building. In three of five personal breathing zone samples taken in the histopathology laboratory, formaldehyde (50000) was detected at concentrations up to 0.17 part per million (ppm) and it was also present in all four of the area air samples at concentrations up to 1.1ppm. The predominant symptoms associated with work in the laboratory included occasional headaches and nose/throat irritation. Mild episodes of dermal irritation and rash were also reported. All carbon-monoxide levels were less than 5ppm. In the kitchens, relative humidity levels were below the recommended range. Temperatures were above the range of temperatures recommended for a medium level of work. The authors conclude that a potential carcinogenic risk existed for workers in laboratories which use formaldehyde. The authors recommend specific measures to lower the risk of formaldehyde exposures in the laboratory.

  12. Center for Women Veterans

    Science.gov (United States)

    ... various organizations and individuals are doing to challenge perceptions about women Veterans. Learn more » #VeteranOfTheDay - Nominate a Veteran Today! Veteran of the Day has been a tradition on VA’s social media pages for more than two years now. This ...

  13. The patient-centered medical home in the Veterans Health Administration.

    Science.gov (United States)

    Rosland, Ann-Marie; Nelson, Karin; Sun, Haili; Dolan, Emily D; Maynard, Charles; Bryson, Christopher; Stark, Richard; Shear, Joanne M; Kerr, Eve; Fihn, Stephan D; Schectman, Gordon

    2013-07-01

    The Veterans Health Administration (VHA) is the largest integrated US health system to implement the patient-centered medical home. The Patient Aligned Care Team (PACT) initiative (implemented 2010-2014) aims to achieve team based care, improved access, and care management for more than 5 million primary care patients nationwide. To describe PACT and evaluate interim changes in PACT-related care processes. Data from the VHA Corporate Data Warehouse were obtained from April 2009 (pre- PACT) to September 2012. All patients assigned to a primary care provider (PCP) at all VHA facilities were included. Nonparametric tests of trend across time points. VHA increased primary care staff levels from April 2010 to December 2011 (2.3 to 3.0 staff per PCP full-time equivalent). In-person PCP visit rates slightly decreased from April 2009 to April 2012 (53 to 43 per 100 patients per calendar quarter; P < .01), while in-person nurse encounter rates remained steady. Large increases were seen in phone encounters (2.7 to 28.8 per 100 patients per quarter; P < .01), enhanced personal health record use (3% to 13% of patients enrolled), and electronic messaging to providers (0.01% to 2.3% of patients per quarter). Post hospitalization follow-up improved (6.6% to 61% of VA hospital discharges), but home telemonitoring (0.8% to 1.4% of patients) and group visits (0.2 to 0.65 per 100 patients per quarter; P < .01) grew slowly. Thirty months into PACT, primary care staff levels and phone and electronic encounters have greatly increased; other changes have been positive but slower.

  14. Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.

    Science.gov (United States)

    Valsangkar, Nakul P; Eppstein, Andrew C; Lawson, Rick A; Taylor, Amber N

    2017-01-01

    There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Following rapid process improvement workshop project rollouts, mean

  15. Patient-centered medical home initiative produced modest economic results for Veterans Health Administration, 2010-12.

    Science.gov (United States)

    Hebert, Paul L; Liu, Chuan-Fen; Wong, Edwin S; Hernandez, Susan E; Batten, Adam; Lo, Sophie; Lemon, Jaclyn M; Conrad, Douglas A; Grembowski, David; Nelson, Karin; Fihn, Stephan D

    2014-06-01

    In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. We analyzed data for fiscal years 2003-12 to assess how trends in health care use and costs changed after the implementation of PACT. We found that PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care-sensitive conditions and outpatient visits with mental health specialists. We estimated that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA. Project HOPE—The People-to-People Health Foundation, Inc.

  16. The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration.

    Science.gov (United States)

    Solimeo, Samantha L; Ono, Sarah S; Lampman, Michelle A M; Paez, Monica B W; Stewart, Gregory L

    2015-01-01

    In this paper we present results of a mixed methods study conducted to identify barriers to team function among staff implementing patient aligned care teams - the Department of Veterans Affairs' patient centered medical home (PCMH) model. Using a convergent mixed methods design, we administered a standardized survey measure (Team and Individual Role Perception Survey) to assess work role challenge and engagement; and conducted discussion groups to gather context pertaining to role change. We found that the role of primary care providers is highly challenging and did not become less difficult over the initial year of implementation. Unexpectedly over the course of the first year nurse care managers reported a decrease in their perceptions of empowerment and clerical associates reported less skill variety. Qualitative data suggest that more skilled team members fail to delegate and share tasks within their teams. We characterize this interprofessional knowledge factor as an empowerment paradox where team members find it difficult to share tasks in ways that are counter to traditionally structured hierarchical roles. Health care systems seeking to implement PCMH should dedicate resources to facilitating within-team role knowledge and negotiation.

  17. Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

    Science.gov (United States)

    Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

    2017-04-01

    Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

  18. Veterans’s Medical Care: FY2014 Appropriations

    Science.gov (United States)

    2013-08-14

    B and flu vaccinations . 25 Department of Veterans Affairs, FY2014 Budget Submission, Medical Programs and Information Technology Programs, Volume 2...veterans of World War II allied nations, and employees receiving preventative occupational immunizations such as Hepatitis A&B and flu vaccinations . The...based counseling centers that provide a wide range of social and psychological services such as professional readjustment counseling to veterans who

  19. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for Department of Veterans Affairs. James J. Peters VA Medical Center, Bronx, NY

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    Schey, Stephen [Intertek Testing Services, North America, Phoenix, AZ (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2014-10-01

    This report focuses on the Department of Veterans Affairs, James J. Peters VA Medical Center (VA - Bronx) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of PEVs into the agencies’ fleets. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively referred to as PEVs) can fulfill the mission requirements.

  20. Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

    Science.gov (United States)

    Mayer, Stephanie B; Levy, James R; Farrell-Carnahan, Leah; Nichols, Michelle G; Raman, Shekar

    2016-07-15

    This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic. Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith's Measure of Morningness/Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist - Civilian Version (PCL-C). Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (standard deviation [SD] 10.6) years, and mean body mass index (BMI) 38.4 kg/m(2) (SD 8.4). By PSQI, 89% rated sleep quality as "poor" (mean = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI. Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD. A commentary on this article appears in this issue on page 943. © 2016 American Academy of Sleep Medicine.

  1. 76 FR 36955 - West Los Angeles VA Medical Center Veterans Programs Enhancement Act of 1998; Master Plan

    Science.gov (United States)

    2011-06-23

    .... One commenter stated that the ``inclusion of the State Veterans Home as Federal VA land in all maps... of the NHV (i.e., the Pacific Branch of the National Home for Disabled Volunteer Soldiers) in the...

  2. Veterans Medical Care: FY2011 Appropriations

    Science.gov (United States)

    2011-03-21

    services to veterans who meet certain eligibility rules including hospital and medical care , disability compensation and pensions,3 education ,4...prosthetic and orthotic devices, including eyeglasses and hearing aids; home health services, hospice care , palliative care , and institutional respite care ...CRS Report for Congress Prepared for Members and Committees of Congress Veterans Medical Care : FY2011 Appropriations Sidath Viranga

  3. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.

    Science.gov (United States)

    Nelson, Karin M; Helfrich, Christian; Sun, Haili; Hebert, Paul L; Liu, Chuan-Fen; Dolan, Emily; Taylor, Leslie; Wong, Edwin; Maynard, Charles; Hernandez, Susan E; Sanders, William; Randall, Ian; Curtis, Idamay; Schectman, Gordon; Stark, Richard; Fihn, Stephan D

    2014-08-01

    In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. To create an index that measures the extent of PCMH implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. We conducted an observational study using data on more than 5.6 million veterans who received care at 913 VHA hospital-based and community-based primary care clinics and 5404 primary care staff from (1) VHA clinical and administrative databases, (2) a national patient survey administered to a weighted random sample of veterans who received outpatient care from June 1 to December 31, 2012, and (3) a survey of all VHA primary care staff in June 2012. Composite scores were constructed for 8 core domains of PACT: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and team-based care. Patient satisfaction, rates of hospitalization and emergency department use, quality of care, and staff burnout. Fifty-three items were included in the PACT Implementation Progress Index (Pi2). Compared with the 87 clinics in the lowest decile of the Pi2, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs 7.53; P burnout (Maslach Burnout Inventory emotional exhaustion subscale, 2.29 vs 2.80; P = .02), lower hospitalization rates for ambulatory care-sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P emergency department use (188 vs 245 visits per 1000 patients; P < .001). The extent of PCMH implementation, as

  4. Veterans Health Administration

    Science.gov (United States)

    ... code here VA » Veterans Health Administration Veterans Health Administration Veterans – Here's how to Avoid Getting the Flu ... Read more » VA Medical Centers The Veterans Health Administration is home to the United States’ largest integrated ...

  5. Elements of the Veterans Health Administration Patient-Centered Medical Home are Associated with Greater Adherence to Oral Hypoglycemic Agents in Patients with Diabetes.

    Science.gov (United States)

    Meo, Nicholas; Wong, Edwin; Sun, Haili; Curtis, Idamay; Batten, Adam; Fihn, Stephan D; Nelson, Karin

    2017-07-05

    In 2010, Veterans Health Administration (VHA) primary care clinics adopted a patient-centered medical home (PCMH) model. This study sought to examine the association between the organizational features related to adoption of PCMH and the level of adherence to oral hypoglycemic agents (OHAs) among patients with diabetes. This retrospective cohort study involved 757 VA clinics that provide primary care to 440,971 patients with diabetes who were taking OHAs in fiscal year 2012. One-year refill-based medication possession ratios (MPRs) were calculated at the patient level. Clinic-level adherence was defined as the proportion of clinics with MPR ≥80%. Risk adjustment of adherence was performed using logistic regression to account for differences in patient populations at clinics. Eight domains of the PCMH model (ie, access, continuity, coordination, teamwork, comprehensive care, self-management, communication, shared decision making) were assessed using items from a previously validated index. Multivariate linear regression was applied to identify PCMH components associated with clinic-level adherence. Patients with diabetes per clinic ranged from 100 to 5011. The average level of adherence to OHAs among clinics ranged from 52.8% to 61.9% (interquartile range = 57.9% to 59.4%). In multivariate analysis, organizational features associated with higher clinic-level adherence included access to routine care (standardized beta [Sβ] = .21, P = .004), having a respectful office staff (Sβ = 0.21, P = .002), and utilization of telephone encounters (Sβ = 0.23, P < .001). Among a national cohort of veterans with diabetes, overall PCMH implementation did not significantly increase adherence to oral hypoglycemic agents, although aspects of implementation were associated with increased adherence. Measures of access to care appear the most significant.

  6. An academic hospitalist model to improve healthcare worker communication and learner education: results from a quasi-experimental study at a Veterans Affairs medical center.

    Science.gov (United States)

    Saint, Sanjay; Fowler, Karen E; Krein, Sarah L; Flanders, Scott A; Bodnar, Timothy W; Young, Eric; Moseley, Richard H

    2013-12-01

    Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied. To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program. Before-and-after design with concurrent control group. A Midwestern Veterans Affairs medical center. Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians). Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination ("shelf" exam) scores, and clinical staff surveys. Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non-Gold team students (84 vs 82; P = 0.006). Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing patient length of stay or readmission rates. © 2013 Society of The Authors. Journal of Hospital Medicine

  7. Health Programs for Veterans

    Science.gov (United States)

    ... Health Administration » Health Programs for Veterans Veterans Health Administration Health Programs for Veterans Beyond the doctors and ... families of patients receiving medical care at major military and VA medical centers Geriatrics & Extended Care Geriatric ...

  8. Role of prolonged surveillance in the eradication of nosocomial scabies in an extended care Veterans Affairs medical center.

    Science.gov (United States)

    Jimenez-Lucho, V E; Fallon, F; Caputo, C; Ramsey, K

    1995-02-01

    Although general guidelines for control of institutional outbreaks of scabies have been published, little information is available on the long-term efficacy of these measures in extended care facilities. An epidemic of scabies occurred in a comprehensive care Veterans Affairs facility as a result of an unrecognized case of crusted scabies, with a total of 112 persons affected during a 12-month period. The initial outbreak occurred in the acute care units, with highest attack rates among roommates of the index patient (11/14, 78%) and nursing staff (27/55, 49%). Despite sustained infection control measures, secondary outbreaks continued to occur in the extended care units. Factors contributing to the persistence of the epidemic were transfer of patients with unrecognized infestation within the facility, prolonged latency period and atypical manifestations in elderly patients, and failure of scabicide treatment. In addition, a role may be played by carriage of scabies mites by infested staff members before they have symptoms. Control of the epidemic was only achieved with the following: increased awareness and better scabies recognition, restriction of staff rotation in the facility, and improved communication among primary providers and infection control personnel. Prolonged surveillance may be required for eradication of nosocomial scabies in extended care settings.

  9. Using intervention mapping to develop and adapt a secondary stroke prevention program in Veterans Health Administration medical centers

    Directory of Open Access Journals (Sweden)

    Andersen Jane

    2010-12-01

    Full Text Available Abstract Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care.

  10. Using intervention mapping to develop and adapt a secondary stroke prevention program in Veterans Health Administration medical centers.

    Science.gov (United States)

    Schmid, Arlene A; Andersen, Jane; Kent, Thomas; Williams, Linda S; Damush, Teresa M

    2010-12-15

    Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM) to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care.

  11. Personal, Medical, and Healthcare Utilization Among Homeless Veterans Served by Metropolitan and Nonmetropolitan Veteran Facilities

    OpenAIRE

    Gordon, Adam J.; Haas, Gretchen L.; Luther, James F.; Hilton, Michael T.; Goldstein, Gerald

    2010-01-01

    This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of...

  12. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging.

    Science.gov (United States)

    Shimada, Stephanie L; Petrakis, Beth Ann; Rothendler, James A; Zirkle, Maryan; Zhao, Shibei; Feng, Hua; Fix, Gemmae M; Ozkaynak, Mustafa; Martin, Tracey; Johnson, Sharon A; Tulu, Bengisu; Gordon, Howard S; Simon, Steven R; Woods, Susan S

    2017-09-01

    We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. We coded 1000 threads of SM communication sampled from 40 primary care teams. Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication.

  13. Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center.

    Science.gov (United States)

    Pocha, Christine

    2010-01-01

    Six Sigma and Lean Thinking are quality initiatives initially deployed in industry to improve operational efficiency leading to better quality and subsequent cost savings. The financial rationale for embarking on this quality journey is clear; applying it to today's health care remains challenging. The cost of medical care is increasing at an alarming rate; most of these cost increases are attributed to an aging population and technological advances; therefore, largely beyond control. Furthermore, health care cost increases are caused by unnecessary operational inefficiency associated with the direct medical service delivery process. This article describes the challenging journey of implementing Six Sigma methodology at a tertiary care medical center. Many lessons were learned; however, of utmost importance were team approach, "buy in" of the stakeholders, and the willingness of team members to change daily practice and to adapt new and innovative ways how health care can be delivered. Six Sigma incorporated as part of the "company's or hospital's culture" would be most desirable but the learning curve will be steep.

  14. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

    Data.gov (United States)

    Department of Veterans Affairs — Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health care benefit program designed for the dependents of certain Veterans....

  15. Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center.

    Science.gov (United States)

    D'Souza, Maria F; Davagnino, Judith; Hastings, S Nicole; Sloane, Richard; Kamholz, Barbara; Twersky, Jack

    2015-06-01

    Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides home-based dementia care and caregiver support for individuals with dementia and their family caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on a consultation basis. The objectives of this study were to describe the COACH program in its first 2 years of operation, assess alignment of program components with quality measures, report characteristics of program participants, and compare rates of placement outside the home with those of a nontreatment comparison group using a retrospective cohort design. Participants were community-dwelling individuals with dementia aged 65 and older who received primary care in the medical center's outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133), and a control group of dyads who were referred to the program and met clinical eligibility criteria but did not enroll (n = 29). Measures included alignment with Dementia Management Quality Measures and time to placement outside the home during 12 months of follow-up after referral to COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process measures identified using quality measures and that COACH delivers several other valuable services to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups (P = .99). The present study demonstrates the successful implementation of a home-based care coordination intervention for persons with dementia and their family caregivers that is strongly aligned with quality measures. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  16. 38 CFR 21.6420 - Coordination with the Veterans Service Center.

    Science.gov (United States)

    2010-07-01

    ... VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational... Coordination with the Veterans Service Center. It is the responsibility of the VR&E Division to inform the...

  17. Veterans Medical Care: FY2010 Appropriations

    Science.gov (United States)

    2010-01-21

    construction of state- owned nursing homes and domiciliary facilities and collaborates with the Department of Defense (DOD) in sharing health care ... domiciliary care , or travel for family members of veterans receiving mental health services from the VA except for such travel performed beyond a 100-mile...institutional respite care , geriatric evaluation, adult day healthcare - $15 per day; domiciliary care - $5 per day) Priority Group 1 (service

  18. A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center.

    Science.gov (United States)

    Broyles, Lauren Matukaitis; Rodriguez, Keri L; Kraemer, Kevin L; Sevick, Mary Ann; Price, Patrice A; Gordon, Adam J

    2012-05-02

    Unhealthy alcohol use includes the spectrum of alcohol consumption from risky drinking to alcohol use disorders. Routine alcohol screening, brief intervention (BI) and referral to treatment (RT) are commonly endorsed for improving the identification and management of unhealthy alcohol use in outpatient settings. However, factors which might impact screening, BI, and RT implementation in inpatient settings, particularly if delivered by nurses, are unknown, and must be identified to effectively plan randomized controlled trials (RCTs) of nurse-delivered BI. The purpose of this study was to identify the potential barriers and facilitators associated with nurse-delivered alcohol screening, BI and RT for hospitalized patients. We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large urban Veterans Affairs Medical Center. Transcripts were analyzed using modified grounded theory techniques to identify key themes regarding anticipated barriers and facilitators to nurse-delivered screening, BI and RT in the inpatient setting. A total of 33 medical-surgical nurses (97% female, 83% white) participated in one of seven focus groups. Nurses consistently anticipated the following barriers to nurse-delivered screening, BI, and RT for hospitalized patients: (1) lack of alcohol-related knowledge and skills; (2) limited interdisciplinary collaboration and communication around alcohol-related care; (3) inadequate alcohol assessment protocols and poor integration with the electronic medical record; (4) concerns about negative patient reaction and limited patient motivation to address alcohol use; (5) questionable compatibility of screening, BI and RT with the acute care paradigm and nursing role; and (6) logistical issues (e.g., lack of time/privacy). Suggested facilitators of nurse-delivered screening, BI, and RT focused on provider- and system-level factors related to: (1) improved provider knowledge, skills, communication, and collaboration

  19. New to care: demands on a health system when homeless veterans are enrolled in a medical home model.

    Science.gov (United States)

    O'Toole, Thomas P; Bourgault, Claire; Johnson, Erin E; Redihan, Stephen G; Borgia, Matthew; Aiello, Riccardo; Kane, Vincent

    2013-12-01

    We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use. We used case-control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011. We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use.

  20. 38 CFR 17.90 - Medical care for veterans receiving vocational training under 38 U.S.C. chapter 15.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Medical care for veterans... Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Vocational Training and Health-Care Eligibility Protection for Pension Recipients § 17.90 Medical care for veterans receiving vocational training under 38 U...

  1. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  2. Medical contraindications to estrogen and contraceptive use among women veterans.

    Science.gov (United States)

    Judge, Colleen P; Zhao, Xinhua; Sileanu, Florentina E; Mor, Maria K; Borrero, Sonya

    2017-10-27

    Women veterans have high rates of medical comorbidities and may be particularly vulnerable to adverse health outcomes associated with unintended pregnancy. The objective of the study was to estimate the prevalence of medical contraindications to estrogen-containing combined hormonal contraception among women veterans of reproductive age and to evaluate the relationship between contraindications and contraceptive use. This was a secondary analysis of data from a cross-sectional, telephone-based survey with a national sample of 2302 female veterans, aged 18-45 years, who use the Veterans Administration Healthcare System for primary care. This analysis included women at risk of unintended pregnancy, defined as heterosexually active and not pregnant or trying to conceive and with no history of hysterectomy or infertility. Seven contraindications to combined hormonal contraception were identified using survey data or medical diagnosis codes: hypertension; coronary artery disease; active migraine in women older than 35 years or migraine with aura; smoking in women older than 35 years; and a history of thromboembolism, stroke, or breast cancer. Outcomes were current use of combined hormonal contraception and contraceptive method type (combined hormonal contraception, and other prescription methods, nonprescription methods or no method). Multivariable logistic and multinomial regression were used to assess the relationship between contraindications and combined hormonal contraception use and method type, respectively. Among 1169 women veterans at risk of unintended pregnancy, 339 (29%) had at least 1 contraindication to combined hormonal contraception. The most prevalent conditions were hypertension (14.9%) and migraine (8.7%). In adjusted analyses, women with contraindications were less likely than women without contraindications to report use of combined hormonal contraception (adjusted odds ratio, 0.54, 95% confidence interval, 0.37-0.79). Relative to use of combined

  3. A Taxonomy of medical comorbidity for veterans who are homeless.

    Science.gov (United States)

    Goldstein, Gerald; Luther, James F; Jacoby, Aaron M; Haas, Gretchen L; Gordon, Adam J

    2008-08-01

    Homeless veterans have numerous medical and behavioral health problems. Grouping homeless people based on comorbidity patterns may assist in determining severity of illness and triaging health care more effectively. We sought to determine if a finite number of profiles could be identified related to demographic characteristics, living situation, length of homelessness, and referral areas using interview data from 2,733 veterans who were presently or recently homeless. We considered 12 disorders: eye problems, hypertension, cardiovascular problems, COPD/emphysema, tuberculosis, gastrointestinal problems, hepatic disease, neurologic disorders, orthopedic problems, skin problems, and trauma. Ratings were evaluated using cluster analysis. Comparison statistics were used to compare intercluster differences in demographics, homeless situation, and referral recommendations. A four-cluster solution is proposed: generalized illness, hepatic disease, lung disease, and neurologic disorder. Medical health problems are common and heterogeneous in homeless individuals. Classifications of these problems may be useful in planning treatment and predicting outcome.

  4. Effect of the Veterans Affairs Medical System on plastic surgery residency training.

    Science.gov (United States)

    Ravin, Adam G; Gottlieb, Neil B; Wang, Howard T; Meade, Ricardo A; Humphrey, J Stewart; Schwarz, Karl W; Levin, L Scott; Tyler, Douglas S; Erdmann, Detlev

    2006-02-01

    Teaching hospitals within the Veterans Affairs Health System perform the majority of complex and high-risk surgical procedures in the veteran patient population. Residency positions in the Veterans Affairs Medical System are usually part of a rotational educational system within a university-based residency, and plastic surgeons in training are a major work force and health care provider. The purpose of this study was to evaluate the current effect of the Veterans Affairs Medical System on plastic surgery residency training. A 6-year (January of 1998 to December of 2003) review was performed of procedures completed at the Durham Veterans Affairs Medical Center, Section of Plastic Surgery. Procedures were divided into the following categories: extremities and trunk; breast and cosmetic; head and neck, including excision of skin lesions; hand surgery; craniomaxillofacial surgery; and other. Only procedures performed in the main operating room were reviewed and analyzed. In addition, a detailed review was performed of major head and neck reconstructions with free tissue transfer. A total of 1655 operative procedures were performed in 1290 patients. The ratio of men to women was 6:1 (1112 men and 178 women). Patients ranged in age from 26 to 97 years (average age, 62.7 years). Procedures in the extremities and trunk (n = 193, 11.7 percent), breast and cosmetic (n = 228, 13.8 percent), hand surgery (n = 155, 9.4 percent), and other (n = 275, 16.6 percent) categories were comparably distributed. Although the head and neck category accounted for the highest number of procedures (n = 766, 46.3 percent), the majority of these procedures were simple excisions of skin tumors (n = 612). There were significantly fewer major craniomaxillofacial cases (n = 38, 2.3 percent). Data from the retrospective analysis reveal that a broad spectrum of plastic surgical procedures is performed within the Veterans Affairs Health System, serving as a tremendous resource for resident training

  5. 78 FR 55671 - Hospital Care and Medical Services for Camp Lejeune Veterans

    Science.gov (United States)

    2013-09-11

    ..., Drug abuse, Health care, Health facilities, Health professions, Health records, Homeless, Medical.... 17.400;''. 0 3. Amend Sec. 17.108(e)(2) by removing ``or post-Gulf War combat- exposed veterans'' and adding, in its place, ``post-Gulf War combat- exposed veterans, or Camp Lejeune veterans pursuant to Sec...

  6. Effect of center-based counseling for veterans and veterans' families on long-term mental health outcomes.

    Science.gov (United States)

    O'Donnell, Meaghan; Varker, Tracey; Perry, Desmond; Phelps, Andrea

    2013-12-01

    The Veterans and Veterans Families Counselling Service (VVCS), established by the Australian government, plays a pivotal role in providing mental health services to veterans and their families. This research explored the impact of center-based psychological counseling on depression, anxiety, stress, and alcohol use severity. A stratified sample of VVCS clients were invited to participate in this study. Data were collected on intake to the program, at the fifth counseling session, and 12 months after the commencement of counseling. Repeated-measures general linear model analyses were conducted to examine the impact of center-based counseling on depression, anxiety, stress, and alcohol severity over time. VVCS center-based counseling resulted in a significant reduction in depression, anxiety, stress, and alcohol use severity after five sessions, and these improvements were maintained over the next 12 months. Despite these improvements, however, participants continued to report moderate-to-severe levels of mental health problems. VVCS center-based counseling successfully reduced depression, anxiety, stress, and alcohol use symptom severity of veterans and their families. However, the clinical profiles of this population are often complex and challenges remain in terms of addressing the mental health needs of this group. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  7. Caregivers Create a Veteran-Centric Community in VHA Medical Foster Homes.

    Science.gov (United States)

    Haverhals, Leah M; Manheim, Chelsea E; Gilman, Carrie V; Jones, Jacqueline; Levy, Cari

    2016-01-01

    The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.

  8. Use of alcoholic beverages in VA medical centers

    Directory of Open Access Journals (Sweden)

    Qadri S Faiz

    2006-10-01

    Full Text Available Abstract Background Benzodiazepines are the first-line choice for the treatment of alcohol withdrawal syndrome. However, several hospitals continue to provide alcoholic beverages through their formulary for the treatment of alcohol withdrawal. While there are data on the prevalence of this practice in academic medical centers, there are no data on the availability of alcoholic beverages at the formularies of the hospitals operated by the department of Veteran's Affairs. Methods In this study, we surveyed the Pharmacy managers at 112 Veterans' Affairs Medical Centers (VAMCs to ascertain the availability of alcohol on the VAMC formularies, and presence or lack of a policy on the use of alcoholic beverages in their VA Medical Center. Results Of the pharmacy directors contacted, 81 responded. 8 did not allow their use, while 20 allowed their use. There was a lack of a consistent policy across the VA medical centers on availability and use of alcoholic beverages for the treatment of alcohol withdrawal syndrome. Conclusion There is lack of uniform policy on the availability of alcoholic beverages across the VAMCs, which may create potential problems with difference in the standards of care.

  9. Identifying Axial Spondyloarthritis in Electronic Medical Records of US Veterans.

    Science.gov (United States)

    Walsh, Jessica A; Shao, Yijun; Leng, Jianwei; He, Tao; Teng, Chia-Chen; Redd, Doug; Treitler Zeng, Qing; Burningham, Zachary; Clegg, Daniel O; Sauer, Brian C

    2017-09-01

    Large database research in axial spondyloarthritis (SpA) is limited by a lack of methods for identifying most types of axial SpA. Our objective was to develop methods for identifying axial SpA concepts in the free text of documents from electronic medical records. Veterans with documents in the national Veterans Health Administration Corporate Data Warehouse between January 1, 2005 and June 30, 2015 were included. Methods were developed for exploring, selecting, and extracting meaningful terms that were likely to represent axial SpA concepts. With annotation, clinical experts reviewed sections of text containing the meaningful terms (snippets) and classified the snippets according to whether or not they represented the intended axial SpA concept. With natural language processing (NLP) tools, computers were trained to replicate the clinical experts' snippet classifications. Three axial SpA concepts were selected by clinical experts, including sacroiliitis, terms including the prefix spond*, and HLA-B27 positivity (HLA-B27+). With supervised machine learning on annotated snippets, NLP models were developed with accuracies of 91.1% for sacroiliitis, 93.5% for spond*, and 97.2% for HLA-B27+. With independent validation, the accuracies were 92.0% for sacroiliitis, 91.0% for spond*, and 99.0% for HLA-B27+. We developed feasible and accurate methods for identifying axial SpA concepts in the free text of clinical notes. Additional research is required to determine combinations of concepts that will accurately identify axial SpA phenotypes. These novel methods will facilitate previously impractical observational research in axial SpA and may be applied to research with other diseases. © 2016, American College of Rheumatology.

  10. Assessment of admissions policies for veteran corpsmen and medics applying to physician assistant educational programs.

    Science.gov (United States)

    Michaud, Ed; Jacques, Paul F; Gianola, F J; Harbert, Ken

    2012-01-01

    The purpose of this study was to assess the admission policies, experiences, and attitudes of physician assistant (PA) program directors with regard to recruiting, admitting, and training veteran corpsmen and medics. A descriptive survey consisting of 18 questions was distributed to all 154 PA program directors in the United States. One hundred ten (71.4%) program directors participated in the survey. Veterans were admitted into 83.6% of programs in the years 2008-2010, and accounted for an average of 2.6% of all students. A minority of PA programs accepted college credits earned by veterans for their military training (45.3%) or for their off-duty education (28.4%). Few PA programs participated in the Yellow Ribbon Program (16%) or actively recruited veterans (16%). Over half of PA programs (56.7%) would be more likely to give special consideration to the admission of veteran corpsmen and medics if it was easier to equate their military education and experience to the program's admission prerequisites. The most frequently reported benefits for educating veteran corpsmen and medics in PA programs are their health care and life experiences, maturity, and motivation. Barriers for educating veterans include veterans' lack of academic preparedness for graduate education, a lack of time/access for recruiting, and the cost of PA school. Most PA program directors cited multiple benefits for educating veteran corpsmen and medics, but veterans face barriers for admission into PA programs. Approaches are discussed for facilitating the transition of corpsmen and medics from the military to careers as PAs.

  11. Predictors of patient communication in psychiatric medication encounters among veterans with serious mental illnesses.

    Science.gov (United States)

    Hack, Samantha M; Medoff, Deborah R; Brown, Clayton H; Fang, Lijuan; Dixon, Lisa B; Klingaman, Elizabeth A; Park, Stephanie G; Kreyenbuhl, Julie A

    2016-06-01

    Person-centered psychiatric services rely on consumers actively sharing personal information, opinions, and preferences with their providers. This research examined predictors of consumer communication during appointments for psychiatric medication prescriptions. The Roter Interaction Analysis System was used to code recorded Veterans Affairs psychiatric appointments with 175 consumers and 21 psychiatric medication prescribers and categorize communication by purpose: biomedical, psychosocial, facilitation, or rapport-building. Regression analyses found that greater provider communication, symptomology, orientation to psychiatric recovery, and functioning on the Repeatable Battery for the Assessment of Neuropsychological Status Attention and Language indices, as well as consumer diagnostic label, were positive predictors of consumer communication, though the types of communication impacted varied. Provider communication is the easiest variable to intervene on to create changes in consumer communication. Future research should also consider how cognitive and symptom factors may impact specific types of consumer communication in order to identify subgroups for targeted interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  12. Do medical house officers value the health of veterans differently from the health of non-veterans?

    Directory of Open Access Journals (Sweden)

    Luckhaupt Sara

    2004-04-01

    Full Text Available Abstract Background Little information is available regarding medical residents' perceptions of patients' health-related quality of life. Patients cared for by residents have been shown to receive differing patterns of care at Veterans Affairs facilities than at community or university settings. We therefore examined: 1 how resident physicians value the health of patients; 2 whether values differ if the patient is described as a veteran; and 3 whether residency-associated variables impact values. Methods All medicine residents in a teaching hospital were asked to watch a digital video of an actor depicting a 72-year-old patient with mild-moderate congestive heart failure. Residents were randomized to 2 groups: in one group, the patient was described as a veteran of the Korean War, and in the other, he was referred to only as a male. The respondents assessed the patient's health state using 4 measures: rating scale (RS, time tradeoff (TTO, standard gamble (SG, and willingness to pay (WTP. We also ascertained residents' demographics, risk attitudes, residency program type, post-graduate year level, current rotation, experience in a Veterans Affairs hospital, and how many days it had been since they were last on call. We performed univariate and multivariable analyses using the RS, TTO, SG and WTP as dependent variables. Results Eighty-one residents (89.0% of eligible participated, with 36 (44.4% viewing the video of the veteran and 45 (55.6% viewing the video of the non-veteran. Their mean (SD age was 28.7 (3.1 years; 51.3% were female; and 67.5% were white. There were no differences in residents' characteristics or in RS, TTO, SG and WTP scores between the veteran and non-veteran groups. The mean RS score was 0.60 (0.14; the mean TTO score was 0.80 (0.20; the mean SG score was 0.91 (0.10; and the median (25th, 75th percentile WTP was $10,000 ($7600, $20,000 per year. In multivariable analyses, being a resident in the categorical program was

  13. Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care.

    Science.gov (United States)

    Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J

    2017-09-01

    Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.

  14. Increased risk among older veterans of prescribing psychotropic medication in the absence of psychiatric diagnoses.

    Science.gov (United States)

    Wiechers, Ilse R; Kirwin, Paul D; Rosenheck, Robert A

    2014-06-01

    This study uses Veterans Health Administration (VHA) pharmacy and encounter claims to evaluate the use of psychotropic medications without a psychiatric diagnosis across age groups. National VHA administrative data for fiscal year 2010 (FY2010) were used to identify all veterans who filled a prescription for at least one psychotropic medication from VHA (N = 1.85 million). Bivariate and multivariate analyses were used to compare the proportion of these veterans without any psychiatric diagnosis, across age groups, adjusting for possible medical indications. Analyses were repeated for six different classes of psychotropic medications and comparing mental health utilizers and non-mental health utilizers. Comparisons were made to prescribing of HIV and diabetes medications without an indicated diagnosis. Of all VHA patients prescribed a psychotropic medication in FY2010, 30% had no psychiatric diagnosis, with highest proportions among veterans ages 65-85. This practice was most frequent among nonmental health utilizers and far more prevalent for psychotropic medications than for HIV or diabetes medications. Logistic regression analysis found that age greater than 65 was the strongest predictor of being prescribed a psychotropic without a psychiatric diagnosis. Adjustment for possible medical use of psychotropics and overall medical comorbidity did not substantially alter these trends. Older veterans, especially those not using specialty mental healthcare, are more likely to be prescribed psychotropic medications in the absence of a psychiatric diagnosis, perhaps representing unnecessary use, under-diagnosis of mental illness, or incomplete documentation. Published by Elsevier Inc.

  15. PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War.

    Science.gov (United States)

    Schlenger, William E; Mulvaney-Day, Norah; Williams, Christianna S; Kulka, Richard A; Corry, Nida H; Mauch, Danna; Nagler, Caryn F; Ho, Chia-Lin; Marmar, Charles R

    2016-05-01

    The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.

  16. PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War

    National Research Council Canada - National Science Library

    Schlenger, William E; Mulvaney-Day, Norah; Williams, Christianna S; Kulka, Richard A; Corry, Nida H; Mauch, Danna; Nagler, Caryn F; Ho, Chia-Lin; Marmar, Charles R

    2016-01-01

    Objective:The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD...

  17. Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study.

    Science.gov (United States)

    Brown, George R; Jones, Kenneth T

    2016-04-01

    There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status. Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population. In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups. This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

  18. US veterans use vitamins and supplements as substitutes for prescription medication.

    Science.gov (United States)

    Goldstein, Jennifer N; Long, Judith A; Arevalo, Doris; Ibrahim, Said A; Mao, Jun J

    2014-12-01

    Vitamins and supplements are the most commonly used form of complementary and alternative medicine in the United States. Growing research suggests that patients substitute vitamins and supplements for their prescription medications. The reasons might include cost of prescription medications and discordant patient and doctor health belief systems. To investigate the prevalence of substitution of vitamins and supplements for prescription medications among veterans who receive care in the VA health care system and whether substitution is associated with prescription rationing due to cost, treatment beliefs, or distrust of the health system. Cross-sectional observational survey. Primary care patients (n=275) at the Philadelphia VA Medical Center. Medication substitution, prescription medication rationing, treatment beliefs, and health system distrust were measured with structured instruments. Multivariate logistic regression was performed with substitution as the dependent variable. A significant number of primary care patients in the VA system use vitamins and supplements 206 (75%). The prevalence of medication substitution is high 48 (18%). Medication substitution is strongly associated with prescription rationing due to cost (adjusted odds ratio 6.3, 95% confidence interval: 2.0-19.5, P=0.001). Similarly, greater belief in complementary and alternative approaches to care positively predicts medication substitution (adjusted odds ratio 1.08, 95% confidence interval: 1.01-1.15, P=0.011). There is no significant association between health system distrust and likelihood of medication substitution. Medication substitution is prevalent in this sample of inner city primary care patients who receive care in the VA system. Cost of prescriptions and belief in the value of complementary and alternative approaches to care appear to be associated with this patient-driven treatment decision.

  19. Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care

    Directory of Open Access Journals (Sweden)

    Lorilei M Richardson

    2016-11-01

    Full Text Available Objective: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. Methods: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. Findings: The diverse factors influencing condition prioritization reflected three overarching themes: (1 the perceived role of a condition in the body, (2 self-management tasks, and (3 pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. Conclusion: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient–provider communication regarding the importance placed on different conditions.

  20. A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity.

    Science.gov (United States)

    Erickson, Zachary D; Kwan, Crystal L; Gelberg, Hollie A; Arnold, Irina Y; Chamberlin, Valery; Rosen, Jennifer A; Shah, Chandresh; Nguyen, Charles T; Hellemann, Gerhard; Aragaki, Dixie R; Kunkel, Charles F; Lewis, Melissa M; Sachinvala, Neena; Sonza, Patrick A; Pierre, Joseph M; Ames, Donna

    2017-04-01

    Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits. We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System. We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups. Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy. One group received "Lifestyle Balance" (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive "Usual Care" (UC) consisting of weight monitoring and provision of self-help. Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly. Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. "Lifestyle Balance" integrates well with VA healthcare's patient-centered "Whole Health" approach. ClinicalTrials.gov identifier NCT01052714.

  1. Medical Care Needs of Returning Veterans with PTSD: Their Other Burden

    Science.gov (United States)

    Chiu, Victor Y.; Iqbal, Samina; Berg, Eric A.; Laungani, Kaajal J.; Cronkite, Ruth C.; Pavao, Joanne; Kimerling, Rachel

    2010-01-01

    ABSTRACT BACKGROUND There has been considerable focus on the burden of mental illness (including post-traumatic stress disorder, PTSD) in returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, but little attention to the burden of medical illness in those with PTSD. OBJECTIVES (1) Determine whether the burden of medical illness is higher in women and men OEF/OIF veterans with PTSD than in those with No Mental Health Conditions (MHC). (2) Identify conditions common in those with PTSD. DESIGN Cross-sectional study using existing databases (Fiscal Year 2006–2007). SETTING Veterans Health Administration (VHA) patients nationally. PATIENTS All 90,558 OEF/OIF veterans using VHA outpatient care nationally, categorized into strata: PTSD, Stress-Related Disorders, Other MHCs, and No MHC. MEASUREMENTS (1) Count of medical conditions; (2) specific medical conditions (from ICD9 codes, using Agency for Health Research and Quality’s Clinical Classifications software framework). MAIN RESULTS The median number of medical conditions for women was 7.0 versus 4.5 for those with PTSD versus No MHC (p PTSD patients, the most frequent conditions among women were lumbosacral spine disorders, headache, and lower extremity joint disorders, and among men were lumbosacral spine disorders, lower extremity joint disorders, and hearing problems. These high frequency conditions were more common in those with PTSD than in those with No MHC. CONCLUSIONS Burden of medical illness is greater in women and men OEF/OIF veteran VHA users with PTSD than in those with No MHC. Health delivery systems serving them should align clinical program development with their medical care needs. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1497-4) contains supplementary material, which is available to authorized users. PMID:20853066

  2. 75 FR 29366 - ``Homeless Veterans' Reintegration Program (HVRP) National Technical Assistance Center...

    Science.gov (United States)

    2010-05-25

    ... of the Assistant Secretary for Veterans' Employment and Training ``Homeless Veterans' Reintegration... the Homeless Veterans' Reintegration Program (HVRP) to include the Homeless Female Veterans and... to expedite the reintegration of homeless Veterans into the labor force. In order to assist the USDOL...

  3. Use of court-ordered supervised disulfiram therapy at DVA medical centers in the United States.

    Science.gov (United States)

    Martin, Brandon; Mangum, Laura; Beresford, Thomas P

    2005-01-01

    Having reported high adherence to court-mandated disulfiram treatment, we hypothesized that other Department of Veterans Affairs (DVA) medical centers would report frequent use of this modality. Telephone interviews with DVA substance abuse clinics in 48 of the 50 states matched the national DVA frequencies. Phone survey responders reported disulfiram prescription as never/rarely 63%, sometimes 32%, and often 5%, while court-ordered disulfiram was used never/rarely 95%, sometimes 3%, and often 2%. Nationally, disulfiram prescriptions covered only 0.07% of all veterans seen. These data suggest a need for a re-evaluation of disulfiram as an underused treatment for alcohol dependence.

  4. PTSD, Psychotropic Medication Use, and the Risk of Dementia Among US Veterans: A Retrospective Cohort Study.

    Science.gov (United States)

    Mawanda, Francis; Wallace, Robert B; McCoy, Kimberly; Abrams, Thad E

    2017-05-01

    To determine the associations between PTSD, psychotropic medication use, and the risk for dementia. Retrospective cohort. Nationwide sample of US veterans (N = 417,172) aged ≥56 years during fiscal year (FY) 2003 without a diagnosis of dementia or mild cognitive impairment at baseline (FY02-03) and ≥1 clinical encounter every 2 years during follow-up (FY04-12). Demographic characteristics; diagnosis of PTSD, dementia, and medical and psychiatric comorbidity (defined by ICD-9 codes); and psychotropic medication use including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), novel antidepressants (NA), benzodiazepines (BZA), and atypical antipsychotics (AA). Cox proportional hazard models examined for associations between PTSD diagnosis, psychotropic medication use, and risk for a dementia diagnosis. PTSD diagnosis significantly increased the risk for dementia diagnosis (HR = 1.35; [95% CI = 1.27-1.43]). However, there were significant interactions between PTSD diagnosis and use of SSRIs (P dementia diagnosis. HR for dementia diagnosis among veterans diagnosed with PTSD and not using psychotropic medications was 1.55 [1.45-1.67]. Among veterans diagnosed with PTSD prescribed SSRI, SNRI, or AA, HR for dementia diagnosis varied by drug class use ranging from 1.99 for SSRI to 4.21 for AA, relative to veterans without a PTSD diagnosis and no psychotropic medication receipt. BZAs or SNRIs use at baseline was associated with a significantly increased risk for dementia diagnosis independent of a PTSD diagnosis. PTSD diagnosis is associated with an increased risk for dementia diagnosis that varied with receipt of psychotropic medications. Further research would help to delineate if these findings are due to differences in PTSD severity, psychiatric comorbidity, or independent effects of psychotropic medications on cognitive decline. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics

  5. Comparing Mobile Health Strategies to Improve Medication Adherence for Veterans With Coronary Heart Disease (Mobile4Meds): Protocol for a Mixed-Methods Study.

    Science.gov (United States)

    Park, Linda G; Collins, Eileen G; Shim, Janet K; Whooley, Mary A

    2017-07-18

    Adherence to antiplatelet medications is critical to prevent life threatening complications (ie, stent thrombosis) after percutaneous coronary interventions (PCIs), yet rates of nonadherence range from 21-57% by 12 months. Mobile interventions delivered via text messaging or mobile apps represent a practical and inexpensive strategy to promote behavior change and enhance medication adherence. The Mobile4Meds study seeks to determine whether text messaging or a mobile app, compared with an educational website control provided to all Veterans, can improve adherence to antiplatelet therapy among patients following acute coronary syndrome (ACS) or PCI. The three aims of the study are to: (1) determine preferences for content and frequency of text messaging to promote medication adherence through focus groups; (2) identify the most patient-centered app that promotes adherence, through a content analysis of all commercially available apps for medication adherence and focus groups centered on usability; and (3) compare adherence to antiplatelet medications in Veterans after ACS/PCI via a randomized clinical trial (RCT). We will utilize a mixed-methods design that uses focus groups to achieve the first and second aims (N=32). Patients will be followed for 12 months after being randomly assigned to one of three arms: (1) customized text messaging, (2) mobile app, or (3) website-control groups (N=225). Medication adherence will be measured with electronic monitoring devices, pharmacy records, and self-reports. Enrollment for the focus groups is currently in progress. We expect to enroll patients for the RCT in the beginning of 2018. Determining the efficacy of mobile technology using a Veteran-designed protocol to promote medication adherence will have a significant impact on Veteran health and public health, particularly for individuals with chronic diseases that require strict medication adherence. ClinicalTrials.gov NCT03022669.

  6. Male veterans with complicated urinary tract infections: Influence of a patient-centered antimicrobial stewardship program.

    Science.gov (United States)

    Carbo, James F; Ruh, Christine A; Kurtzhalts, Kari E; Ott, Michael C; Sellick, John A; Mergenhagen, Kari A

    2016-12-01

    The influence of antimicrobial stewardship programs (ASPs) on outcomes in male veterans treated for complicated urinary tract infection has not been determined. This was a retrospective cohort study encompassing the study period January 1, 2005-October 31, 2014, which was conducted at a 150-bed Veterans Affairs Healthcare System facility in Buffalo, NY. Male veterans admitted for treatment of complicated urinary tract infection were identified using ICD-9-CM codes. Outcomes before and after implementation of a patient-centered ASP, including duration of antibiotic therapy, length of hospitalization, readmission within 30 days, and Clostridium difficile infection were compared. Interventions resulting from the ASP were categorized. Of the 1,268 patients screened, 241 met criteria for inclusion in the study (n = 118 and n = 123 in the pre-ASP and ASP group, respectively). Duration of antibiotic therapy was significantly shorter in the ASP group (10.32 days vs 11.96 days; P complicated urinary tract infection. Implementation of an ASP was associated with significant decreases in duration of antibiotic therapy and length of hospitalization, without adversely affecting 30-day readmission rates. Published by Elsevier Inc.

  7. Sleep quality and the role of sleep medications for veterans with chronic pain.

    Science.gov (United States)

    Chapman, Judith B; Lehman, Cassandra L; Elliott, Janette; Clark, J David

    2006-01-01

    The purpose of this study was to investigate the nature of sleep problems in veterans presenting to a pain clinic, factors that predict likelihood of being prescribed a sleep medication, types of medications prescribed, and the relationships between sleep medication use and sleep quality, pain, and depression. Participants were 201 consecutive patients referred to a Veterans Affairs outpatient pain clinic. They were administered the Pittsburgh Sleep Quality Index, Multidimensional Pain Inventory, and Beck Depression Inventory at intake and 2-month follow-up. Sleep and opioid medication prescriptions were also monitored. Pain severity did not predict global sleep quality; global sleep quality was not predictive of pain severity. Greater depression predicted both more severe pain and more sleep impairment. Having previously been prescribed such medications was the only significant predictor of being prescribed a sleep medication at the time of the 2-month assessment. For the 45% of participants on sleep medications, these medications were not associated with any significant change in pain factors or depression. However, sleep medication use was associated with worse global sleep quality, sleep duration, and sleep efficiency. Opioid prescription was not a significant predictor of sleep factors, pain-related variables, or depression symptoms. Results suggest depression may contribute more significantly to sleep problems than pain-related variables in this population. The data suggest the need for controlled, prospective studies of sleep medication to further investigate the impact of sleep medications on sleep components in patients with chronic pain.

  8. Opioid pain medication prescriptions obtained through emergency medical visits in the Veterans Health Administration.

    Science.gov (United States)

    Grasso, Michael A; Dezman, Zachary D W; Grasso, Clare T; Jerrard, David A

    This study sought to characterize national patterns for opioid pain medication (OPM) prescriptions received during emergency medical encounters in the Veterans Health Administration (VA). The authors conducted a retrospective study of all emergency department (ED) visits by adults in the VA between January 2009 and June 2015. We examined demographics, comorbidities, utilization measures, diagnoses, and prescriptions. The percentage of ED visits that culminated in the receipt of a prescription for an OPM. There were 6,721,134 emergency medical visits by 1,708,545 individuals during the study period. An OPM was prescribed during 913,872 visits (13.6 percent), and 407,408 individuals (27.5 percent) received at least one OPM prescription. Prescriptions for OPMs peaked in 2011 at 14.5 percent, declining to 12.3 percent in 2015. The percentage of prescriptions limited to 12 pills increased from 25.0 to 32.4 percent. The heaviest users (top 1.5 percent, n = 7,247) received an average 602.5 total doses, and had at least 10 ED visits during the study period. The most frequently prescribed OPMs were acetaminophen/hydrocodone, followed by tramadol and acetaminophen/oxycodone. Receiving a prescription was associated with younger patients, musculoskeletal diagnoses, higher pain scores, a history of chronic pain, a history of mental illness, a history of substance abuse, prior heavy prescription OPM use, and lower participation in outpatient services. The writing of OPM prescriptions after an ED visit is on the decline in the VA. Compliance with prescribing guidelines is increasing, but is not yet at goal.

  9. Teamwork and delegation in medical homes: primary care staff perspectives in the Veterans Health Administration.

    Science.gov (United States)

    True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L

    2014-07-01

    The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.

  10. Lameness surgeon joins equine medical center faculty

    OpenAIRE

    Musick, Marjorie

    2008-01-01

    Dr. M. Norris Adams has joined Virginia Tech's Marion duPont Scott Equine Medical Center as a clinical assistant professor in equine lameness and surgery. In this role, Adams will focus on elective orthopedic procedures and will assist with the expansion of the center's outpatient services program.

  11. Exposure to High Risk Medications is Associated with Worse Outcomes in Older Veterans with Chronic Pain

    Science.gov (United States)

    Makris, Una E; Pugh, Mary Jo; Alvarez, Carlos A; Berlowitz, Dan R; Turner, Barbara J; Aung, KoKo; Mortensen, Eric M

    2016-01-01

    Background Chronic pain is common, costly, and leads to significant morbidity in older adults, yet we have limited data on medication safety. We sought to evaluate the association of incident High Risk Medication in the Elderly (HRME) with mortality, emergency department (ED) or hospital care among older adults with chronic pain. Methods A retrospective Veterans Health Administration cohort study was conducted examining older Veterans with chronic pain diagnoses and use of incident HRME (opioids, skeletal muscle relaxants, antihistamines, and psychotropics). Outcomes evaluated included all-cause mortality, ED visits, or inpatient hospital care. Descriptive statistics summarized variables for the overall cohort, the chronic pain cohort, and those with and without HRME. Separate generalized linear mixed-effect regression models were used to examine the association of incident HRME on each outcome, controlling for potential confounders. Results Among 1,807,404 Veterans who received VA care in 2005–2006, 584,066 (32.3%) had chronic pain; 45,945 Veterans with chronic pain (7.9%) had incident HRME exposure. The strongest significant associations of incident HRME were for: high-risk opioids with all-cause hospitalizations (OR 2.08, 95%CI 1.95–2.23); skeletal muscle relaxants with all-cause ED visits (OR 2.62, 95%CI 2.52–2.73) and mortality (OR 0.80, 95%CI 0.74–0.86); antihistamines with all-cause ED visits (OR 2.82 95%CI 2.72–2.95); and psychotropics with all-cause hospitalizations (OR 2.15, 95%CI 1.96–2.35). Conclusions Our data indicate that incident HRME is associated with clinically important adverse outcomes in older Veterans with chronic pain and highlight the importance of being judicious with prescribing certain classes of drugs in this vulnerable population. PMID:26418380

  12. Validity of Center for Epidemiologic Studies Depression (CES-D scale in a sample of Iraq and Afghanistan Veterans

    Directory of Open Access Journals (Sweden)

    Ana R Quiñones

    2016-04-01

    Full Text Available Objectives: Optimal depression screening necessitates measurement tools that are valid across varied populations and in the presence of comorbidities. Methods: This study assessed the test properties of two versions of the Center for Epidemiologic Studies Depression scale against psychiatric diagnoses established by the Mini International Neuropsychiatric Interview among a clinical sample of US Veterans deployed during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Participants (N = 359 recruited from two Department of Veterans Affairs hospitals completed a clinical interview, structured diagnostic interview, and self-reported measures. Results: Based on diagnostic interview and the Diagnostic and Statistical Manual of Mental Disorders 4th Edition criteria, 29.5% of the sample met diagnostic criteria for major depressive disorder and 26.5% met diagnostic criteria for post-traumatic stress disorder. Both Center for Epidemiologic Studies Depression-20 and Center for Epidemiologic Studies Depression-10 scales performed well and almost identically against the Mini International Neuropsychiatric Interview-major depressive disorder in identifying Veterans with major depressive disorder (Center for Epidemiologic Studies Depression-20 area under the Receiver Operating Characteristic curve 91%; Center for Epidemiologic Studies Depression-10 area under the ROC curve 90%. Overall, higher cut points for the Center for Epidemiologic Studies Depression scales performed better in correctly identifying true positives and true negatives for major depressive disorder (Center for Epidemiologic Studies Depression-20 cut point 18+ sensitivity 92% specificity 72%; Center for Epidemiologic Studies Depression-10 cut point 10+ sensitivity 92% specificity 69%. Conclusions: The specificity of the Center for Epidemiologic Studies Depression scales was poor among Veterans with co-occurring post-traumatic stress disorder (13% and 16%. Veterans with post

  13. Medical center farmers markets: a strategic partner in the patient-centered medical home.

    Science.gov (United States)

    George, Daniel R; Rovniak, Liza S; Kraschnewski, Jennifer L; Morrison, Kathy J; Dillon, Judith F; Bates, Beth Y

    2013-08-01

    The number of medical center-based farmers markets has increased in the past decade, but little is known about how such organizations contribute to the preventive health goals of the patient-centered medical home. In 2010, we started a seasonal farmers market at Penn State Hershey Medical Center to help support the institution's commitment to the medical home. We obtained descriptive data on the farmers market from hospital and market records and tracking information on the market's Facebook and Twitter sites. We computed summary measures to characterize how the market has begun to meet the 6 standards of the 2011 National Committee for Quality Assurance's report on the medical home. During the 2010 and 2011 seasons, 146 medical center volunteers from 40 departments formed 23 interprofessional teams that spent an average of 551 volunteer hours per season at the market, providing health screenings (n = 695) and speaking to customers (n = 636) about preventive health. Fifty-five nonmedical community health partners provided 208 hours of service at the market alongside medical center staff. Market programming contributed to 5 regional preventive health partnerships and created opportunities for interprofessional mentoring, student leadership, data management, development of social media skills, and grant-writing experience. The market contributed to all 6 medical home standards outlined by the National Committee for Quality Assurance. Medical center markets can support medical home standards. With systematic tracking of the health effects and integration with electronic medical health records, markets hold potential to contribute to comprehensive patient-centered care.

  14. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Topics For Veterans For Researchers Research Oversight Special Groups Caregivers Combat Veterans & their Families Readjustment Counseling (Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans Seniors & Aging Veterans Volunteers Women Veterans ...

  15. Academic Medical Centers as digital health catalysts.

    Science.gov (United States)

    DePasse, Jacqueline W; Chen, Connie E; Sawyer, Aenor; Jethwani, Kamal; Sim, Ida

    2014-09-01

    Emerging digital technologies offer enormous potential to improve quality, reduce cost, and increase patient-centeredness in healthcare. Academic Medical Centers (AMCs) play a key role in advancing medical care through cutting-edge medical research, yet traditional models for invention, validation and commercialization at AMCs have been designed around biomedical initiatives, and are less well suited for new digital health technologies. Recently, two large bi-coastal Academic Medical Centers, the University of California, San Francisco (UCSF) through the Center for Digital Health Innovation (CDHI) and Partners Healthcare through the Center for Connected Health (CCH) have launched centers focused on digital health innovation. These centers show great promise but are also subject to significant financial, organizational, and visionary challenges. We explore these AMC initiatives, which share the following characteristics: a focus on academic research methodology; integration of digital technology in educational programming; evolving models to support "clinician innovators"; strategic academic-industry collaboration and emergence of novel revenue models. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Family-centered care for military and veteran families affected by combat injury.

    Science.gov (United States)

    Cozza, Stephen J; Holmes, Allison K; Van Ost, Susan L

    2013-09-01

    The US military community includes a population of mostly young families that reside in every state and the District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and Veteran families live in civilian communities and receive care from clinicians with limited experience in the treatment of military families. Though all military families may have vulnerabilities based upon their exposure to deployment-related experiences, those affected by combat injury have unique additional risks that must be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental and interpersonal functions that support children's health and well-being, and disconnect families from military resources. Treatment of combat-injured service members must therefore include a family-centered strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian families, and effective strategies for maintaining family health while dealing with illness and injury.

  17. Medical center staff attitudes about spanking.

    Science.gov (United States)

    Gershoff, Elizabeth T; Font, Sarah A; Taylor, Catherine A; Foster, Rebecca H; Garza, Ann Budzak; Olson-Dorff, Denyse; Terreros, Amy; Nielsen-Parker, Monica; Spector, Lisa

    2016-11-01

    Several medical professional organizations, including the American Academy of Pediatrics, recommend that parents avoid hitting children for disciplinary purposes (e.g., spanking) and that medical professionals advise parents to use alternative methods. The extent to which medical professionals continue to endorse spanking is unknown. This study is the first to examine attitudes about spanking among staff throughout medical settings, including non-direct care staff. A total of 2580 staff at a large general medical center and 733 staff at a children's hospital completed an online survey; respondents were roughly divided between staff who provide direct care to patients (e.g., physicians, nurses) and staff who do not (e.g., receptionists, lab technicians). Less than half (44% and 46%) of staff at each medical center agreed that spanking is harmful to children, although almost all (85% and 88%) acknowledged that spanking can lead to injury. Men, staff who report being religious, and staff who held non-direct care positions at the medical center reported stronger endorsement of spanking and perceived their co-workers to be more strongly in favor of spanking. Non-direct care staff were more supportive of spanking compared with direct care staff on every item assessed. All staff underestimated the extent to which their co-workers held negative views of spanking. If medical centers and other medical settings are to lead the charge in informing the community about the harms of spanking, comprehensive staff education about spanking is indicated. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Developing physician leaders in academic medical centers.

    Science.gov (United States)

    Bachrach, D J

    1997-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.*

  19. First things first: foundational requirements for a medical home in an academic medical center.

    Science.gov (United States)

    Forman, Jane; Harrod, Molly; Robinson, Claire; Annis-Emeott, Ann; Ott, Jessica; Saffar, Darcy; Krein, Sarah L; Greenstone, Clinton L

    2014-07-01

    In 2010, the Veterans Health Administration (VHA) began implementation of its medical home, Patient Aligned Care Teams (PACT), in 900 primary care clinics nationwide, with 120 located in academically affiliated medical centers. The literature on Patient-Centered Medical Home (PCMH) implementation has focused mainly on small, nonacademic practices. To understand the experiences of primary care leadership, physicians and staff during early PACT implementation in a VHA academically affiliated primary care clinic and provide insights to guide future PCMH implementation. We conducted a qualitative case study during early PACT implementation. Primary care clinical leadership, primary care providers, residents, and staff. Between February 2011 and March 2012, we conducted 22 semi-structured interviews, purposively sampling participants by clinic role, and convenience sampling within role. We also conducted observations of 30 nurse case manager staff meetings, and collected data on growth in the number of patients, staff, and physicians. We used a template organizing approach to data analysis, using select constructs from the Consolidated Framework for Implementation Research (CFIR). Establishing foundational requirements was an essential first step in implementing the PACT model, with teamlets able to do practice redesign work. Short-staffing undermined development of teamlet working relationships. Lack of co-location of teamlet members in clinic and difficulty communicating with residents when they were off-site hampered communication. Opportunities to educate and reinforce PACT principles were constrained by the limited clinic hours of part-time primary care providers and residents, and delays in teamlet formation. Large academic medical centers face special challenges in implementing the medical home model. In an era of increasing emphasis on patient-centered care, our findings will inform efforts to both improve patient care and train clinicians to move from physician

  20. 38 CFR 12.21 - Action upon death of veteran.

    Science.gov (United States)

    2010-07-01

    ... veteran at a Department of Veterans Affairs hospital, center or domiciliary activity while receiving care... of the Department of Veterans Affairs hospital, center, or domiciliary activity having jurisdiction...

  1. Reduction in patient enrollment in the Veterans Health Administration after media coverage of adverse medical events.

    Science.gov (United States)

    Weeks, William B; Mills, Peter D

    2003-12-01

    Health care organizations may experience costs associated with preventable adverse events in the form of poor brand image and subsequent patient disenrollment. A retrospective cohort design was used to determine whether media coverage of adverse events that occurred in Veterans Health Administration (VHA) hospitals was associated with subsequent veteran disenrollment. Twenty-four newspaper reports of medical adverse events that occurred between 1994 and 1999 within the VHA system were identified. Regionally adjusted changes in enrollment rates for VHA facilities that had reported adverse events were compared with those that had not one year before and one and three years after publication of the newspaper reports. Facilities that had published reports of adverse events had lower enrollment rates after publication of the report for two groups of veterans. Within the VHA system, health care organizations involved in adverse events that generated publicity suffered a greater rate of patient disenrollment. If safe patient care practices can reduce adverse publicity, they may enhance corporate value by maintaining enrollment of the patient population.

  2. 77 FR 58913 - Veterans' Rural Health Advisory Committee, Notice of Meeting

    Science.gov (United States)

    2012-09-24

    ... AFFAIRS Veterans' Rural Health Advisory Committee, Notice of Meeting The Department of Veterans Affairs... provision of VA health care to enrolled Veterans residing in rural areas, and discusses ways to improve and... Office of Rural Health (ORH) Telehealth Projects funded; Louis A. Johnson Medical Center Women's Health...

  3. [Cluster Analysis of Medication Laws for Treating Coronary Heart Disease by Distinguished Veteran Doctors of Traditional Chinese Medicine].

    Science.gov (United States)

    Ren, Yi; Chen, Zhi-qiang; Zhang, Min-zhou; Guo, Li-heng; He, De-ying

    2016-04-01

    To provide inspiration and ideas for clinical treatment of coronary heart disease (CHD) by data mining technology based frequency analysis and cluster analysis of medical records, prescriptions and herbs in treating CHD by distinguished veteran doctors of traditional Chinese Dedicine (TCM). Totally 386 medical cases were retrieved from Wanfang Data, Chinese Scientific Journals Database (VIP medical information resources system, China National Knowledge Infrastructure (CNKI), and Typical Collections of Medical Cases by Contemporary Distinguished Veteran Doctors of Traditional Chinese Medicine. They input into database trimmed after unified standard. Medication laws of CHD by distinguished veteran doctors of TCM were analyzed using frequency analysis and cluster analysis, and so on. Distinguished veteran doctors of TCM frequently used top ten herbs in treatment of C D as Salvia miltiorrhiz , Ligusticum wallichii, Trichosanthes kirilowi, Pinellia ternat, Angelica sinensis, Poria coco stragalu , Panax ginseng, Allium macrostemon, and Radix Ophiopogonis. Cluster analysis summarized that there were 16 herb pairs commonly used, 7drug assemblies consisting of 3 herbs and 5 drug assemblies consisting of multiple herbs. Distinguished veteran doctors of TCM mainly used herbs assemblies capable for invigorating Pi to resolve phlegm, and promoting qi and activating blood circulation in treating CHD. Meanwhile, they concurrently used herbs combination of nourishing Xin and tranquilization, and regulating yin and yang.

  4. Academic medical centers write their own rules.

    Science.gov (United States)

    Freischlag, Julie Ann

    2011-09-01

    The interaction between pharmaceutical and device companies and hospitals and physicians has undergone significant transformation in the past few years due to the public's perception that bias may result when such relationships are not disclosed and monitored. Policies need to be written by medical centers and hospitals to preserve and retain the trust of the public. The policy written by Johns Hopkins Medical Institutions is outlined and its implications discussed in this article. The importance of such policies in guiding young faculty and staff as they begin their careers cannot be overemphasized. Copyright © 2011. Published by Mosby, Inc.

  5. Clinical characteristics of veterans prescribed high doses of opioid medications for chronic non-cancer pain.

    Science.gov (United States)

    Morasco, Benjamin J; Duckart, Jonathan P; Carr, Thomas P; Deyo, Richard A; Dobscha, Steven K

    2010-12-01

    Little is known about patients prescribed high doses of opioids to treat chronic non-cancer pain, though these patients may be at higher risk for medication-related complications. We describe the prevalence of high-dose opioid use and associated demographic and clinical characteristics among veterans treated in a VA regional healthcare network. Veterans with chronic non-cancer pain prescribed high doses of opioids (≥ 180 mg/day morphine equivalent; n=478) for 90+ consecutive days were compared to two groups with chronic pain: Traditional-dose (5-179 mg/day; n=500) or no opioid (n=500). High-dose opioid use occurred in 2.4% of all chronic pain patients and in 8.2% of all chronic pain patients prescribed opioids long-term. The average dose in the high-dose group was 324.9 (SD=285.1)mg/day. The only significant demographic difference among groups was race (p=0.03) with black veterans less likely to receive high doses. High-dose patients were more likely to have four or more pain diagnoses and the highest rates of medical, psychiatric, and substance use disorders. After controlling for demographic factors and VA facility, neuropathy, low back pain, and nicotine dependence diagnoses were associated with increased likelihood of high-dose prescriptions. High-dose patients frequently did not receive care consistent with treatment guidelines: there was frequent use of short-acting opioids, urine drug screens were administered to only 25.7% of patients in the prior year, and 32.0% received concurrent benzodiazepine prescriptions, which may increase risk for overdose and death. Further study is needed to identify better predictors of high-dose usage, as well as the efficacy and safety of such dosing. Published by Elsevier B.V.

  6. Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

    Science.gov (United States)

    Geiling, James; Rosen, Joseph M; Edwards, Ryan D

    2012-11-01

    War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

  7. Evaluation of Non-Natural Deaths among Veterans: New Mexico Medical Examiner-Investigated Deaths, 2002-2011.

    Science.gov (United States)

    LeBlanc, Melissa R; Clifford, Camille P; Lathrop, Sarah L

    2017-05-01

    While it is recognized that veterans have increased rates of depression, post-traumatic stress disorder (PTSD), suicide, and substance use disorders, rates of homicide and unintentional injury deaths in veterans have been minimally investigated. We evaluated all non-natural deaths in New Mexico veterans between 2002 and 2011 in comparison with non-natural deaths among non-veterans. We reviewed all decedents in New Mexico with a history of military service and investigated by the medical examiner, excluding natural deaths and deaths due to fall from standing height. The most common manner of death was unintentional injury (62%), most of these deaths due to motor vehicle accidents (29%) followed by unintentional overdose (26%). Suicide rates among veterans were consistently higher than the general population. The most common mechanism of suicide in men was gunshot wound (72%), and intentional overdose in women (49%). Services are needed for veterans that are tailored to all ages and both sexes. © 2016 American Academy of Forensic Sciences.

  8. The Mount Sinai Medical Center, New York.

    Science.gov (United States)

    Butler, R N; Adelman, R

    1988-03-01

    Aging is the third great antecedent to all disease, along with genetic factors and the environment. Yet, the role of aging in the genesis of the conditions of old age constitutes relatively new territory that has not been adequately explored in terms of education, the health care system, and research. A commitment to these areas was made in 1982 when the Mount Sinai Medical Center established the nation's first and only medical school department of geriatrics--the Gerald and May Ellen Ritter Department of Geriatrics and Adult Development. Recognizing that aging of the population constituted a major global public health challenge, leaders of the medical center turned to Robert N. Butler, MD, who was then director of the National Institute on Aging, for guidance in setting up an institute of gerontology and geriatrics. Because only a full-fledged academic department would have a claim on resources, curriculum, and clerkship time, Dr Butler recommended that such a department be developed at Mount Sinai. The Ritter Department of Geriatrics and Adult Development emphasized the wide scope of this new discipline through educational programs, clinical services, health policy studies, and research projects.

  9. Early experiences with big data at an academic medical center

    National Research Council Canada - National Science Library

    Halamka, John D

    2014-01-01

    .... Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an...

  10. Activities Carried Out Under the Veterans' Administration Medical School Assistance and Health Manpower Training Act of 1972 (Public Law 92-541), An Annual Report Prepared by the Veterans' Administration.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

    The third annual report (fiscal year 1979) of the activities carried out under the Veterans' Administration Medical School Assistance and Health Manpower Training Act of 1972 (Public Law 92-541) is presented. Under this special authority grants have been made to assist in the establishment of new state medical schools, to existing medical schools,…

  11. NASA Johnson Space Center Medical Licensing Opportunities

    Science.gov (United States)

    Hernandez-Moya, Sonia

    2009-01-01

    This presentation reviews patented medical items that are available for licensing in the areas of Laboratory Technologies, Medical Devices, Medical Equipment and other technologies that are of interest to the medical community.

  12. Increased Postdeployment Use of Medication for Common Mental Disorders in Danish Gulf War Veterans.

    Science.gov (United States)

    Nissen, Lars Ravnborg; Stoltenberg, Christian; Vedtofte, Mia Sadowa; Nielsen, Anni Brit Sternhagen; Marott, Jacob Louis; Gyntelberg, Finn; Guldager, Bernadette

    2017-03-01

    Gulf War veterans (GWVs) have an elevated risk of reporting symptoms of mental disorders as compared with nondeployed military controls. A difficulty in the Gulf War health research is that most health outcomes are self-reported; therefore, it is highly relevant to study objective outcomes in this line of research. The Danish National Prescription Registry provides an opportunity to use the prescription of drugs as an objective evaluation of the impact of mental health disorders at the individual level. In this study, we investigated the prescription of drugs and postdeployment hospitalizations for mental disorders among GWVs compared with a control population of nonveterans (NVs). A prospective registry study including a cohort of 721 GWVs and a control cohort of 3,629 NVs. Main outcome measures were incidence of (1) use of antidepressants, (2) use of anxiolytic/hypnotic medication, and (3) number of postdeployment psychiatric contacts. The association between outcomes and GWVs status was studied by using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until December 31, 2014. GWVs had an elevated average risk over time for use of both types of medication compared with NV. For use of antidepressants the average hazard rate (HR) was 2.56, with 95% confidence interval (CI) = 2.04-3.21 (p < 0.0001); for use of anxiolytic/hypnotic medication the corresponding results were HR = 1.78, CI = 1.37-2.31 (p < 0.0001). The interaction with time was statistically significant with HR increasing with time for both outcomes. Incident use of antidepressants in GWVs after 10 years was two times higher than among NV, after 20 years it was nearly four times higher than among NV. Incident use of anxiolytic/hypnotic medication was one and a half that of NV after 10 years, but nearly three times that of NV after 20 years. There was no difference in rate of postdeployment psychiatric

  13. 75 FR 39622 - Proposed Information Collection (Health Resource Center Medical Center Payment Form) Activity...

    Science.gov (United States)

    2010-07-09

    ... comment. The PRA submission describes the nature of the information collection and its expected cost and... AFFAIRS Proposed Information Collection (Health Resource Center Medical Center Payment Form) Activity...: Health Resource Center Medical Center Payment Form, VA Form 10-0505. OMB Control Number: 2900-New (10...

  14. Veterans Administration Databases

    Science.gov (United States)

    The Veterans Administration Information Resource Center provides database and informatics experts, customer service, expert advice, information products, and web technology to VA researchers and others.

  15. Plastic surgery within the Veterans Affairs Medical System: proposed modified indications for operative procedures.

    Science.gov (United States)

    Erdmann, Detlev; Pradka, Sarah P; Similie, Ernest; Marcus, Jeffrey R; Moyer, Kurtis E; Shelburne, John D; Tyler, Douglas S; Levin, Scott L

    2009-07-01

    Many plastic surgery procedures span the divide between aesthetic ("cosmetic") and reconstructive surgery. However, definitions and guidelines may be inconsistent, which may decrease patients' access to legitimate procedures. The article aims to assist Veterans' Health Administration-affiliated plastic surgeons in continuing to provide optimal care to the Nation's Veterans and family members, and should be regarded as an open discussion.

  16. A study of ambulatory care education in medical schools and U.S. Department of Veterans Affairs health care facilities.

    Science.gov (United States)

    Robbins, A S; Lussier, R R; Koser, K

    1989-10-01

    A study of ambulatory care and education was conducted by sending questionnaires to U.S. Department of Veterans Affairs hospitals (75) and medical schools (65) prior to the Conference on Ambulatory Care and Education. Responses from 48% of medical schools indicated that there was little required clinical time in ambulatory care (15-20%), as well as faculty resistance and lack of medical school commitment to ambulatory care education. VA respondents (35% sample) also documented relatively little training in ambulatory care at the undergraduate and graduate levels. Numerous barriers to ambulatory care education are mentioned and strategies for overcoming the problems found are discussed.

  17. [Medical controlling as medical economical service center. Successful concept for orthopedics and trauma surgery centers?].

    Science.gov (United States)

    Auhuber, T C; Hoffmann, R

    2015-01-01

    The management of patients from administrative admission through the orthopedic-surgical treatment to completion of the billing is complex. Additional challenges originate from the necessity to treat patients in both outpatient and inpatient departments and in more than one medical sector. A superior coordination is essential for a successful cooperation of the various procedures of controlling. The model of a medical controlling department as a service center with effective competence in the management of service and cost, functions as a successful solution to the problem. Central elements of a successful medical economical case management are a well-defined assignment of tasks and definitions of intersections, the integration of health professionals and administrative employees, the utilization of software for process control and the implementation of inlier controlling.

  18. Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration.

    Science.gov (United States)

    Sayuk, G S; Kanuri, N; Gyawali, C P; Gott, B M; Nix, B D; Rosenheck, R A

    2018-03-01

    While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit. To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role. Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups. A greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use. Despite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk. © 2018 John Wiley & Sons Ltd.

  19. 38 CFR 17.101 - Collection or recovery by VA for medical care or services provided or furnished to a veteran for...

    Science.gov (United States)

    2010-07-01

    ... VA for medical care or services provided or furnished to a veteran for a nonservice-connected... MEDICAL Charges, Waivers, and Collections § 17.101 Collection or recovery by VA for medical care or... section covers collection or recovery by VA, under 38 U.S.C. 1729, for medical care or services provided...

  20. Achieving Medical Currency via Selected Staff Integration in Civilian and Veterans Administration Medical Facilities

    Science.gov (United States)

    2012-10-01

    and the American College of Cardiology exist, their established standards are nonbinding. Instead, each state maintains a board of medical examiners... Congress of the United States, "Cornell University Law School U.S. Code 10 1074," 1 February 2010, http://www.law.cornell.edu/uscode/uscode10...DefenceInternet/DefenceFor/Jobseekers/CivilianC areers/SpecialistRecruitment.htm (accessed 28 January 2011). 32 26. Congress of the United States

  1. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Veterans Not Enrolled in VA Health Care Family Members Frequently Asked Questions Schedule a VA Appointment Conditions & ... Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans Seniors & Aging Veterans Volunteers Women Veterans ...

  2. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Employment Center Returning Service Members Vocational Rehabilitation & Employment Homeless Veterans Women Veterans Minority Veterans Plain Language Surviving Spouses & Dependents Adaptive Sports Program ADMINISTRATION Veterans Health Administration Veterans Benefits Administration National ...

  3. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... at VA Employment Center Returning Service Members Vocational Rehabilitation & Employment Homeless Veterans Women Veterans Minority Veterans Plain Language Surviving Spouses & Dependents Adaptive Sports Program ADMINISTRATION Veterans Health Administration Veterans Benefits Administration ...

  4. Beck PRIDE Center - An Effective Solution for Combat Injured Student Veterans

    Science.gov (United States)

    2016-09-01

    issues included back, neck, knee, and shoulder pain . A coin flip determined if the veteran received Treatment A or Treatment B first. The following is...intake form, 79% reported suffering from mobility impairments (e.g., back, knee, or shoulder pain ), 76% reported suffering from sleep problems (e.g...THIS PAGE U UU 19b. TELEPHONE NUMBER (include area code) 9Sep2011 - 30Jun2016 Nothing listed 54 One purpose of the study is to evaluate the effects

  5. Medical Center Staff Attitudes about Spanking

    OpenAIRE

    Gershoff, Elizabeth T.; Font, Sarah A.; Taylor, Catherine A.; Foster, Rebecca H.; Garza, Ann Budzak; Olson-Dorff, Denyse; Terreros, Amy; Nielsen-Parker, Monica; Spector, Lisa

    2016-01-01

    Several medical professional organizations, including the American Academy of Pediatrics, recommend that parents avoid hitting children for disciplinary purposes (e.g., spanking) and that medical professionals advise parents to use alternative methods. The extent to which medical professionals continue to endorse spanking is unknown. This study is the first to examine attitudes about spanking among staff throughout medical settings, including non-direct care staff. A total of 2,580 staff at a...

  6. Medication wrong route administration: a poisons center-based study

    OpenAIRE

    Bloch-Teitelbaum, Alexandra; Lüde, Saskia; Rauber-Lüthy, Christine; Kupferschmidt, Hugo; Russmann, Stefan; Kullak-Ublick, Gerd A.; Ceschi, Alessandro

    2013-01-01

    OBJECTIVES: To describe clinical effects, circumstances of occurrence, management and outcomes of cases of inadvertent administration of medications by an incorrect parenteral route. METHODS: Retrospective single-center consecutive review of parenteral route errors of medications, reported to our center between January 2006 and June 2010. We collected demographic data and information on medications, route and time of administration, severity of symptoms/signs, treatment, and outcome. RE...

  7. Development of a curriculum and training program in Woman Veterans Health for Internal Medical Residents.

    Science.gov (United States)

    Ceylony, Manju; Porhomayon, Jahan; Pourafkari, Leili; Nader, Nader D

    2017-09-26

    Internal Medicine residents must develop competency as Primary Care Providers, but a gap exists in their curriculum and training with regard to women's reproductive health. With increasing need in VA due to new influx of women veterans it poses problems in recruitment of competent physicians trained in Women's health. An intensive, one-month women's reproductive health curriculum with hands on experience for Internal Medicine residents was provided. Curriculum was taught to the residents who rotated at the Women's Health Clinic for one month. Pre-test and post-test exams were administered. Increase in knowledge of residents in providing gender specific evaluations and management was objectively assessed by changes in post-test scores. Data were analyzed for statistically significant improvement in written tests scores. Total of 47 Internal Medicine residents rotated through Women's Health Center during the evaluation period. All residents completed both pre-test and post-test exams. The average time to complete the pre-test was 20.5 ± 5.4 min and 19.5 ± 4.8 min for post-test. There was no correlation between the time to complete the pre-test exam and the post-test exam. The total score was significantly improved from 8.5 ± 1.6 to 13.2 ± 1.8 (p training with information on women's health that enables them to provide safe and gender appropriate care in primary care settings. This practice will reduce the need for frequent referrals for specialized care and thus provide cost saving for patient and health care on the whole.

  8. Grants for transportation of veterans in highly rural areas. Final rule.

    Science.gov (United States)

    2013-04-02

    The Department of Veterans Affairs (VA) amends its regulations to establish a new program to provide grants to eligible entities to assist veterans in highly rural areas through innovative transportation services to travel to VA medical centers, and to otherwise assist in providing transportation services in connection with the provision of VA medical care to these veterans, in compliance with section 307 of title III of the Caregivers and Veterans Omnibus Health Services Act of 2010. This final rule establishes procedures for evaluating grant applications under the new grant program, and otherwise administering the new grant program.

  9. 38 CFR 3.401 - Veterans.

    Science.gov (United States)

    2010-07-01

    ... domiciliary. (Authority: 38 U.S.C. 501) (3) Spouse, additional compensation for aid and attendance: Date of...) Director of a Department of Veterans Affairs medical center or domiciliary. From day following date of last... from hospitalization (regular or release to non-bed care). (i) Increased disability pension based on...

  10. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Topics For Veterans For Researchers Research Oversight Special Groups Caregivers Combat Veterans & their Families Readjustment Counseling (Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans ...

  11. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... and Media Research Topics For Veterans For Researchers Research Oversight Special Groups Caregivers Combat Veterans & their Families Readjustment Counseling (Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans ...

  12. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Readjustment Counseling (Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans ... Strat Plan FY 2014-2020 VA Plans, Budget, & Performance VA Claims Representation RESOURCES ... Veterans Health Administration Veterans Benefits Administration ...

  13. Lessons learned: mobile device encryption in the academic medical center.

    Science.gov (United States)

    Kusche, Kristopher P

    2009-01-01

    The academic medical center is faced with the unique challenge of meeting the multi-faceted needs of both a modern healthcare organization and an academic institution, The need for security to protect patient information must be balanced by the academic freedoms expected in the college setting. The Albany Medical Center, consisting of the Albany Medical College and the Albany Medical Center Hospital, was challenged with implementing a solution that would preserve the availability, integrity and confidentiality of business, patient and research data stored on mobile devices. To solve this problem, Albany Medical Center implemented a mobile encryption suite across the enterprise. Such an implementation comes with complexities, from performance across multiple generations of computers and operating systems, to diversity of application use mode and end user adoption, all of which requires thoughtful policy and standards creation, understanding of regulations, and a willingness and ability to work through such diverse needs.

  14. 78 FR 73926 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2013-12-09

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... Health Advisory Committee will hold a meeting on January 14-15, 2014, in Room 1G12, Building 1, at the George E. Whalen VA Medical Center (VAMC), 500 Foothill Drive, Salt Lake City, Utah, from 9 a.m. to 5 p.m...

  15. Operations improvement and reengineering at Ohio State University Medical Center.

    Science.gov (United States)

    Marsh, G; Guanciale, T; Simon, M

    1995-08-01

    Rising costs and increasing competition have forced hospitals to respond to the needs of their customers. At Ohio State University Medical Center, operations improvement and reengineering are being used to redesign processes and to position the medical center competitively in today's changing environment. An operations improvement team identified business processes with the greatest opportunity for positive impact based on the goals of the medical center. Next, these areas were prioritized and teams appointed to begin the reengineering process. Reengineering methods focused on specific outcomes, including improved patient satisfaction, reduced cost, and improved clinical and service quality. Throughout the process, the goals and successes of reengineering were communicated to the organization and community.

  16. Medical Informatics in Academic Health Science Centers.

    Science.gov (United States)

    Frisse, Mark E.

    1992-01-01

    An analysis of the state of medical informatics, the application of computer and information technology to biomedicine, looks at trends and concerns, including integration of traditionally distinct enterprises (clinical information systems, financial information, scholarly support activities, infrastructures); informatics career choice and…

  17. Vet Centers. Final rule.

    Science.gov (United States)

    2016-03-02

    The Department of Veterans Affairs (VA) adopts as final an interim final rule that amends its medical regulation that governs Vet Center services. The National Defense Authorization Act for Fiscal Year 2013 (the 2013 Act) requires Vet Centers to provide readjustment counseling services to broader groups of veterans, members of the Armed Forces, including a member of a reserve component of the Armed Forces, and family members of such veterans and members. This final rule adopts as final the regulatory criteria to conform to the 2013 Act, to include new and revised definitions.

  18. Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment.

    Science.gov (United States)

    Locatelli, Sara M; LaVela, Sherri L

    2015-01-01

    Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress.

  19. Equine Medical Center Appoints Veterinary Advisory Board Members

    OpenAIRE

    Nadjar, Ann

    2003-01-01

    A Veterinary Advisory Board, comprised of Virginia- and Maryland-based equine practitioners, has been established to help the Marion duPont Scott Equine Medical Center continue its quest to provide excellence in equine healthcare for the region.

  20. Defining the medical imaging requirements for a rural health center

    CERN Document Server

    2017-01-01

    This book establishes the criteria for the type of medical imaging services that should be made available to rural health centers, providing professional rural hospital managers with information that makes their work more effective and efficient. It also offers valuable insights into government, non-governmental and religious organizations involved in the planning, establishment and operation of medical facilities in rural areas. Rural health centers are established to prevent patients from being forced to travel to distant urban medical facilities. To manage patients properly, rural health centers should be part of regional and more complete systems of medical health care installations in the country on the basis of a referral and counter-referral program, and thus, they should have the infrastructure needed to transport patients to urban hospitals when they need more complex health care. The coordination of all the activities is only possible if rural health centers are led by strong and dedicated managers....

  1. Organization development at work in a medical center.

    Science.gov (United States)

    Russell, A Y; Zimmerman, S; Bruce, R

    1978-01-01

    Organization development can work: Valley Medical Center in San Jose, California, has successfully restructured multiple lines of authority in the process of installing modern management and fiscal control processes.

  2. University of Nebraska Medical Center | Division of Cancer Prevention

    Science.gov (United States)

    Principal investigator: Michael (Tony) A. Hollingsworth, PhD Institution: Research Unit - University of Nebraska Medical Center Title of the PCDC Project This page is under construction. Please check back at a later date. |

  3. Report of VA Medical Training Programs

    Data.gov (United States)

    Department of Veterans Affairs — The Report of VA Medical Training Programs Database is used to track medical center health services trainees and VA physicians serving as faculty. The database also...

  4. [SOROKA UNIVERSITY MEDICAL CENTER: THE ROAD TO LEADERSHIP IN QUALITY OF MEDICAL CARE, SERVICE AND RESEARCH].

    Science.gov (United States)

    Davidson, Ehud; Sheiner, Eyal

    2016-02-01

    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research.

  5. A Medical Center Network for Optimized Lung Cancer Biospecimen Banking

    Science.gov (United States)

    2015-10-01

    1 Award Number: W81XWH-10-1-0818 TITLE: “A Medical Center Network for Optimized Lung Cancer Biospecimen Banking ” PRINCIPAL INVESTIGATOR: Christopher...To) 20Sep2014 - 19Sep2015 4. TITLE AND SUBTITLE “A Medical Center Network for Optimized Lung Cancer Biospecimen Banking ” 5a. CONTRACT NUMBER 5b...Although new subject enrollments and specimen collection have ceased, the LCBRN is committed to the outcome of this project, which is a bank of

  6. A SIMULATION MODEL FOR EMERGENCY MEDICAL SERVICES CALL CENTERS

    NARCIS (Netherlands)

    M. van Buuren (Martin); G.J. Kommer (Geert Jan); R.D. van der Mei (Rob); S. Bhulai (Sandjai); L. Yilmaz; W.K.V. Chan; I. Moon; T.M.K. Roeder; C. Macal; M.D. Rosetti

    2015-01-01

    htmlabstractIn pre-hospital health care the call center plays an important role in the coordination of emergency medical services (EMS). An EMS call center handles inbound requests for EMS and dispatches an ambulance if necessary. The time needed for triage and dispatch is part of the total response

  7. A simulation model for emergency medical services call centers

    NARCIS (Netherlands)

    van Buuren, M.; Kommer, G.J.; van der Mei, R.D.; Bhulai, S.

    2015-01-01

    In pre-hospital health care the call center plays an important role in the coordination of emergency medical services (EMS). An EMS call center handles inbound requests for EMS and dispatches an ambulance if necessary. The time needed for triage and dispatch is part of the total response time to the

  8. A simulation model for emergency medical services call centers

    NARCIS (Netherlands)

    M. van Buuren (Martin); G.J. Kommer (Geert Jan); R.D. van der Mei (Rob); S. Bhulai (Sandjai)

    2015-01-01

    htmlabstractIn pre-hospital health care the call center plays an important role in the coordination of emergency medical services (EMS). An EMS call center handles inbound requests for EMS and dispatches an ambulance if necessary. The time needed for triage and dispatch is part of the total response

  9. Comparing the health status of VA and non-VA ambulatory patients: the veterans' health and medical outcomes studies.

    Science.gov (United States)

    Rogers, William H; Kazis, Lewis E; Miller, Donald R; Skinner, Katherine M; Clark, Jack A; Spiro, Avron; Fincke, R Graeme

    2004-01-01

    The purpose of this study was to compare health status and disease profiles of ambulatory patients in specific Veterans Administration (VA) and civilian healthcare settings. A random sample of 2425 male veterans seeking care at 4 Boston-area VA outpatient clinics, who took part in the Veterans Health Study (VHS) in 1993-1995, were compared to 1318 male patients seeking civilian outpatient care in 3 major metropolitan areas covered in the Medical Outcomes Study (MOS) in 1986. The MOS sampled patients who had 1 of 5 conditions--hypertension, noninsulin-dependent diabetes, recent myocardial infarction, congestive heart failure, or depression. These 2 samples were age adjusted and compared in terms of the SF-36 Health Status/Quality of Life measures, and a list of 100 clinical variables (diagnostic, symptom, and medical event reports) collected with comparable instruments by a trained clinical observer. Individual odds ratios (VHS to MOS) were calculated for each measure and clinical variables. SF-36 measures of patient health in the VHS were lower than those in the MOS by more than one half of a standard deviation (SD) on 4 of 8 scales, by more than one quarter of a SD on the other 4, by 58% of a SD on the physical health summary scale, and by 37% of a SD on the mental health summary scale (P illness burden than did patients in the MOS. Current economic condition and service-connected disability explain most, if not all, of the differences. The differences were clinically and socially meaningful and would be consistent with substantially higher expected healthcare use.

  10. Predictors of homeless veterans' irregular discharge status from a domiciliary care program.

    Science.gov (United States)

    Wenzel, S L; Bakhtiar, L; Caskey, N H; Hardie, E; Redford, C; Sadler, N; Gelberg, L

    1995-01-01

    This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.

  11. Arthritis and Veterans

    Centers for Disease Control (CDC) Podcasts

    2015-11-09

    One in three veterans has arthritis. This podcast provides information on how veterans can improve their quality of life with physical activity and other arthritis management strategies.  Created: 11/9/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 11/9/2015.

  12. Physical Health Conditions Among a Population-Based Cohort of Vietnam-Era Women Veterans: Agreement Between Self-Report and Medical Records.

    Science.gov (United States)

    Kilbourne, Amy M; Schumacher, Karen; Frayne, Susan M; Cypel, Yasmin; Barbaresso, Michelle M; Nord, Kristina M; Perzhinsky, Juliette; Lai, Zongshan; Prenovost, Katherine; Spiro, Avron; Gleason, Theresa C; Kimerling, Rachel; Huang, Grant D; Serpi, Tracey B; Magruder, Kathryn M

    2017-11-01

    Little is known about medical morbidity among women Vietnam-era veterans, or the long-term physical health problems associated with their service. This study assessed agreement comparing data on physical health conditions from self-report and medical records from a population-based cohort of women Vietnam-era Veterans from the Health of Vietnam Era Women's Study (HealthViEWS). Women Vietnam-era veterans (n = 4219) self-completed a survey and interview on common medical conditions. A subsample (n = 900) were contacted to provide permission to obtain medical records from as many as three of their providers. Medical record reviews were conducted using a standardized checklist. Agreement and kappa (agreement beyond chance) were calculated for physical health condition groups. Of the 900, 449 had medical records returned, and of those, 412 had complete surveys/interviews. The most commonly reported conditions based on self-report or medical record review included hypertension, hyperlipidemia, or arthritis. Kappa scores between self-reported conditions and medical record documentation were 0.75-0.91 for hypertension, diabetes, most cancers, and neurological conditions, but lower (k = 0.29-0.55) for cardiovascular diseases, musculoskeletal, and gastrointestinal conditions. Generally, agreement did not significantly vary by different sociodemographic groups. There was relatively high agreement for physical health conditions when self-report was compared with medical record review. As more women are increasingly represented in the military and more veterans in general seek care outside the Veterans Health Administration, accurate measurement of physical health conditions among population-based samples is crucial.

  13. Medical, psychiatric and demographic factors associated with suicidal behavior in homeless veterans.

    Science.gov (United States)

    Goldstein, Gerald; Luther, James Francis; Haas, Gretchen Louise

    2012-08-30

    This study assessed potential for suicidal behaviors associated with sociodemographic, predisposing physical and mental health factors and self-reported psychological problems among homeless veterans in a large northeastern region. Data were obtained from a demographic and clinical history interview conducted with 3595 homeless veterans. Odds-ratio (OR) statistics were used to assess potential for suicidal behavior. Statistically significant ratios were similar for ideation and attempts. The highest ratios were for self-report of depression and difficulty controlling violence, but statistically significant ratios were found for reporting sleeping in a treatment facility the night before the interview, receiving VA support for a psychiatric condition, and the diagnoses of Alcoholism, Mood Disorder and Post Traumatic Stress Disorder (PTSD). Low but statistically significant odds-ratios were obtained for most of the physical health items. A negative odds-ratio was obtained for African-American ethnicity. Logistic regression results indicated that for ideation and attempts items entered first involved subjective report of trouble controlling violent behavior and experiencing depression. High odds ratios for the interview items concerning experiencing serious depression and having difficulties controlling violence may have strong implications for treatment and management of homeless veterans. There may be up to 14-1 odds that an individual who reports being seriously depressed or having difficulty inhibiting aggression may have a serious potential for suicidal behaviors. Published by Elsevier Ireland Ltd.

  14. Perspectives of family and veterans on family programs to support reintegration of returning veterans with posttraumatic stress disorder.

    Science.gov (United States)

    Fischer, Ellen P; Sherman, Michelle D; McSweeney, Jean C; Pyne, Jeffrey M; Owen, Richard R; Dixon, Lisa B

    2015-08-01

    Combat deployment and reintegration are challenging for service members and their families. Although family involvement in mental health care is increasing in the U.S. Department of Veterans Affairs (VA) system, little is known about family members' preferences for services. This study elicited the perspectives of returning Afghanistan and Iraq war veterans with posttraumatic stress disorder and their families regarding family involvement in veterans' mental health care. Semistructured qualitative interviews were conducted with 47 veterans receiving care for posttraumatic stress disorder at the Central Arkansas Veterans Healthcare System or Oklahoma City VA Medical Center and 36 veteran-designated family members. Interviews addressed perceived needs related to veterans' readjustment to civilian life, interest in family involvement in joint veteran/family programs, and desired family program content. Interview data were analyzed using content analysis and constant comparison. Both groups strongly supported inclusion of family members in programs to facilitate veterans' postdeployment readjustment and reintegration into civilian life. Both desired program content focused on information, practical skills, support, and gaining perspective on the other's experience. Although family and veteran perspectives were similar, family members placed greater emphasis on parenting-related issues and the kinds of support they and their children needed during and after deployment. To our knowledge, this is the first published report on preferences regarding VA postdeployment reintegration support that incorporates the perspectives of returning male and female veterans and those of their families. Findings will help VA and community providers working with returning veterans tailor services to the needs and preferences of this important-to-engage population. (c) 2015 APA, all rights reserved).

  15. The Veterans Choice Act: A Qualitative Examination of Rapid Policy Implementation in the Department of Veterans Affairs.

    Science.gov (United States)

    Mattocks, Kristin M; Mengeling, Michelle; Sadler, Anne; Baldor, Rebecca; Bastian, Lori

    2017-07-01

    Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 [Veterans Choice Act (VCA)] to improve access to timely, high-quality health care for Veterans. Although Congress mandated that VCA must begin within 90 days of passage of the legislation, no guidelines were provided in the legislation to ensure that Veterans had access to an adequate number of community providers across different specialties of care or distinct geographic areas, including rural areas of the country. To examine VCA policy implementation across a sampling of Veterans Health Administration (VHA) Medical Centers. We conducted a qualitative study of 43 VHA staff and providers by conducting in-person interviews at 5 VA medical centers in the West, South, and Midwest United States. Interview questions focused on perceptions and experiences with VCA and challenges related to implementation for VHA staff and providers. We identified 3 major themes to guide description of choice implementation: (1) VCA implemented too rapidly with inadequate preparation; (2) community provider networks insufficiently developed; and (3) communication and scheduling problems with subcontractors may lead to further delays in care. Our evaluation suggests that VCA was implemented far too rapidly, with little consideration given to the adequacy of community provider networks available to provide care to Veterans. Given the challenges we have highlighted in VCA implementation, it is imperative that the VHA continue to develop care coordination systems that will allow the Veterans to receive seamless care in the community.

  16. Benefits of student-centered tandem teaching in medical English

    Directory of Open Access Journals (Sweden)

    Antić Zorica

    2015-01-01

    Full Text Available This paper addresses some of the key notions about English for special purposes with special regard to English for medical purposes. The content was determined by observations and based on authors’ professional experience. The starting point of a medical English course is a thorough analysis of students’ needs, which is then used in course design and definition of appropriate learning goals. The student is at the center of learning and it is necessary to establish a positive cooperation between students and teachers. As medical English course is highly context-based, the inclusion of medical teachers can offer many opportunities for a successful learning process.

  17. 38 CFR 17.277 - Third-party liability/medical care cost recovery.

    Science.gov (United States)

    2010-07-01

    .../medical care cost recovery. 17.277 Section 17.277 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...)-Medical Care for Survivors and Dependents of Certain Veterans § 17.277 Third-party liability/medical care cost recovery. The Center will actively pursue third-party liability/medical care cost recovery in...

  18. Consumerism: forcing medical practices toward patient-centered care.

    Science.gov (United States)

    Ozmon, Jeff

    2007-01-01

    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  19. Mental Health, Quality of Life, and Health Functioning in Women Veterans: Differential Outcomes Associated with Military and Civilian Sexual Assault

    Science.gov (United States)

    Suris, Alina; Lind, Lisa; Kashner, T. Michael; Borman, Patricia D.

    2007-01-01

    The present study examined psychiatric, physical, and quality-of-life functioning in a sample of 270 women veterans receiving outpatient treatment at a Veterans Affairs medical center. Participants were interviewed regarding their civilian (CSA) and military sexual assault (MSA) histories, and data regarding quality of life and health outcomes…

  20. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Injury Study Center Homeless Veterans Returning Service Members Rural Veterans Seniors & Aging Veterans Volunteers Women Veterans Careers, Job Help & Training Find a Job with VA Health Care Jobs (VA Careers) Travel Nurses Get Job ...

  1. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans Seniors & Aging Veterans Volunteers Women Veterans Careers, Job Help & Training Find a Job with VA Health Care Jobs (VA Careers) Travel Nurses Get Job Help ...

  2. STOR: From Pilot Project to Medical Center Implementation

    Science.gov (United States)

    Henke, J.; Whiting-O'Keefe, Q.E.; Whiting, A.; Schaffner, R.; Schnake, R.; Goldstein, R.; Abrego, J.

    1988-01-01

    Summary Time Oriented Record (STOR) is a clinical information system operating at the University of California San Francisco Medical Center (UCSF). It provides two major services: on-line display of clinical information in the hospitals and clinics and an ambulatory medical record that partially replaces the traditional paper medical record for outpatient patient visits. In 1985 STOR was approved for clinic-wide implementation in the UCSF ambulatory care clinics. The implementation will be completed in September 1989. STOR captures clinical data directly from clinicians via hand written notations and ancillary data from other UCSF computers via a local area network. Development on STOR is continuing in order to meet the changing and diversified environment of inpatient and outpatient practices found in a university medical center.

  3. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Us FAQs Ask a Question Toll Free Numbers Homeless Veterans Chat VA » Health Care » PTSD: National Center ... Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans Seniors & Aging ...

  4. [Medication rules of famous veteran traditional Chinese medicine doctor in treatment of chronic bronchitis based on implicit structure model].

    Science.gov (United States)

    Chen, Li-Ping; Cai, Yong-Min; Li, Jian-Sheng

    2017-04-01

    To explore the medication rules of famous veteran traditional Chinese medicine (TCM) doctors in treatment of chronic bronchitis, a structured medical record database for famous veteran TCM doctors in modern clinical books was established. First, Lantern 3.1.2(Kongmin light) implicit structure analysis software was used to build an implicit structure model and make an implicit interpretation. Then, SAS 9.1 was adopted to mine herb-herb, herb-symptom and herb-syndrome association rules. Through the mining, 1 274 commonly used herbs for chronic bronchitis were found, including liquorice, bitter almond, pinellia, dried tangerine or orange peel, poria cocos. The medicine types included antiasthmatic medicine, qi-tonifying medicine, and heat-phlegm removing medicine. The medicine tastes included sweet, pungent and bitter. The meridian distributions included lung, spleen and stomach channels. The famous commonly used prescriptions included Xiaoqinglong decoction, Maxing Shigan decoction and Erchen decoction. The 147-herb implicit structure model for the first diagnosis was built to get 44 hidden variables, 88 hidden classes, 7 comprehensive clustering models, 9 dual herb associations, 50 triple herb associations and 89 quadruple associations. Totally 297 medical records for the second diagnosis were compared to obtain 24 herb-symptom associations, which reduced ephedra, bitter almond, pinellia and added poria cocos, atractylodes, dangshen, 20 dual herb associations and 8 triple herb associations. A model for the top 83 symptoms and top 96 herbs in the first diagnosis was built to get 50 hidden variables and 101 hidden classes. The commonly used herbs of famous veteran TCM doctors included bitter almond, pinellia, dried tangerine or orange peel, poria cocos, which feature mild property and sweet favor and enter lung, spleen, kidney meridians; the commonly herbal pairs included atractylodes and poria cocos, asarum, fructus schisandrae and pinellia, as well as poria cocos

  5. Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration.

    Science.gov (United States)

    Bachhuber, Marcus A; Roberts, Christopher B; Metraux, Stephen; Montgomery, Ann Elizabeth

    2015-01-01

    To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment. Addiction treatment programs operated by the US Department of Veterans Affairs (VA). All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA's national homelessness screener. Self-reported homelessness or imminent risk of homelessness. The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively). The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

  6. Vet Centers. Interim final rule.

    Science.gov (United States)

    2015-08-04

    The Department of Veterans Affairs (VA) is amending its medical regulation that governs Vet Center services. The National Defense Authorization Act for Fiscal Year 2013 (the 2013 Act) requires Vet Centers to provide readjustment counseling services to broader groups of veterans, members of the Armed Forces, including a member of a reserve component of the Armed Forces, and family members of such veterans and members. This interim final rule amends regulatory criteria to conform to the 2013 Act, to include new and revised definitions.

  7. Veterans Crisis Line: Videos About Reaching out for Help

    Science.gov (United States)

    Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There ... see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from ...

  8. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Administration I'm Good. But are you ready to listen? see more videos from Veterans Health Administration ... videos from Veterans Health Administration Vet Centers: Here to Help see more videos from Veterans Health Administration ...

  9. Supply chain optimization at an academic medical center.

    Science.gov (United States)

    Labuhn, Jonathan; Almeter, Philip; McLaughlin, Christopher; Fields, Philip; Turner, Benjamin

    2017-08-01

    A successful supply chain optimization project that leveraged technology, engineering principles, and a technician workflow redesign in the setting of a growing health system is described. With continued rises in medication costs, medication inventory management is increasingly important. Proper management of central pharmacy inventory and floor-stock inventory in automated dispensing cabinets (ADCs) can be challenging. In an effort to improve control of inventory costs in the central pharmacy of a large academic medical center, the pharmacy department implemented a supply chain optimization project in collaboration with the medical center's inhouse team of experts on process improvement and industrial engineering. The project had 2 main components: (1) upgrading and reconfiguring carousel technology within an expanded central pharmacy footprint to generate accurate floor-stock inventory replenishment reports, which resulted in efficiencies within the medication-use system, and (2) implementing a technician workflow redesign and algorithm to right-size the ADC inventory, which decreased inventory stockouts (i.e., incidents of depletion of medication stock) and improved ADC user satisfaction. Through a multifaceted approach to inventory management, the number of stockouts per month was decreased and ADC inventory was optimized, resulting in a one-time inventory cost savings of $220,500. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  10. Tracking patient satisfaction at an academic medical center.

    Science.gov (United States)

    Lancaster, W; Lancaster, J

    1992-01-01

    Rising consumer expectations for convenient, quality health care is forcing many hospitals to focus increasing attention to measuring consumer perception and satisfaction with the care provided. At the University of Virginia Health Sciences Center, getting in close touch with the consumer has assumed a strategic position. As one part of the evolving Marketing Information System, a patient satisfaction tracking system is being designed to illicit patient feedback and hospital responses to service issues, assess patient satisfaction with various services, serve as a benchmark for evaluating changes in satisfaction over time, and provide necessary information for medical center planning, marketing and evaluation.

  11. An Architecture for Continuous Data Quality Monitoring in Medical Centers.

    Science.gov (United States)

    Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard

    2015-01-01

    In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

  12. [NEURO-ONCOLOGY A NEW FIELD IN DAVIDOFF CANCER CENTER AT RABIN MEDICAL CENTER].

    Science.gov (United States)

    Yust-Katz, Shlomit; Limon, Dror; Abu-Shkara, Ramez; Siegal, Tali

    2017-08-01

    Neuro-oncology is a subspecialty attracting physicians from medical disciplines such as neurology, neurosurgery, pediatrics, oncology, and radiotherapy. It deals with diagnosis and management of primary brain tumors, as well as metastatic and non-metastatic neurological manifestations that frequently affect cancer patients including brain metastases, paraneoplastic syndromes and neurological complications of cancer treatment. A neuro-oncology unit was established in Davidoff Cancer Center at Rabin Medical Center. It provides a multidisciplinary team approach for management of brain tumors and services, such as expert outpatient clinics and inpatient consultations for the departments of oncology, hematology, bone marrow transplantation and other departments in the Rabin Medical Center. In addition, expert consultation is frequently provided to other hospitals that treat cancer patients with neurological manifestations. The medical disciplines that closely collaborate for the daily management of neuro-oncology patients include radiotherapy, hematology, oncology, neuro-surgery, neuro-radiology and neuro-pathology. The neuro-oncology center is also involved in clinical and laboratory research conducted in collaboration with researchers in Israel and abroad. The new service contributes substantially to the improved care of cancer patients and to the advance of research topics in the field of neuro-oncology.

  13. The value of a writing center at a medical university.

    Science.gov (United States)

    Ariail, Jennie; Thomas, Suzanne; Smith, Tom; Kerr, Lisa; Richards-Slaughter, Shannon; Shaw, Darlene

    2013-01-01

    Students often enter graduate healthcare/biomedical schools with insufficient undergraduate instruction in effective writing, yet the ability to write well affects their career opportunities in health care and in scientific research. The present study was conducted to determine the value and effectiveness of instruction by faculty with expertise in teaching writing at a writing center at an academic health science center. Two separate sources of data were collected and analyzed. First, an anonymous campus-wide survey assessed students' satisfaction and utilization of the university's Writing Center. Second, a nonexperimental objective study was conducted comparing a subsample of students who used versus those who did not receive instruction at the Writing Center on quality of writing, as determined by an evaluator who was blind to students' utilization status. From the campus-wide survey, more than 90% of respondents who used the center (which was 26% of the student body) agreed that it was a valuable and effective resource. From the objective study of writing quality, students who used the Writing Center were twice as likely as students who did not to receive an A grade on the written assignment, and the blinded evaluator accurately estimated which students used the Writing Center based on the clarity of writing. The instruction at the Writing Center at our university is highly valued by students, and its value is further supported by objective evidence of efficacy. Such a center offers the opportunity to provide instruction that medical and other healthcare students increasingly need without requiring additions to existing curricula. By developing competency in writing, students prepare for scholarly pursuits, and through the process of writing, they engage critical thinking skills that can make them more attuned to narrative and more reflective and empathetic in the clinical setting.

  14. Energy use baselining study for the National Naval Medical Center

    Energy Technology Data Exchange (ETDEWEB)

    Parker, G.B.; Halverson, M.A.

    1992-04-01

    This report provides an energy consumption profile for fourteen buildings at the National Naval Medical Center (NNMC) in Bethesda, Maryland. Recommendations are also made for viable energy efficiency projects funded with assistance from the servicing utility (Potomic Electric Power Company) in the form of rebates and incentives available in their Demand Side Management (DSM) program and through Shared Energy Savings (SES) projects. This report also provides estimates of costs and potential energy savings of the recommended projects.

  15. Advanced earthquake monitoring system for U.S. Department of Veterans Affairs medical buildings--instrumentation

    Science.gov (United States)

    Kalkan, Erol; Banga, Krishna; Ulusoy, Hasan S.; Fletcher, Jon Peter B.; Leith, William S.; Reza, Shahneam; Cheng, Timothy

    2012-01-01

    In collaboration with the U.S. Department of Veterans Affairs (VA), the National Strong Motion Project (NSMP; http://nsmp.wr.usgs.gov/) of the U.S. Geological Survey has been installing sophisticated seismic systems that will monitor the structural integrity of 28 VA hospital buildings located in seismically active regions of the conterminous United States, Alaska, and Puerto Rico during earthquake shaking. These advanced monitoring systems, which combine the use of sensitive accelerometers and real-time computer calculations, are designed to determine the structural health of each hospital building rapidly after an event, helping the VA to ensure the safety of patients and staff. This report presents the instrumentation component of this project by providing details of each hospital building, including a summary of its structural, geotechnical, and seismic hazard information, as well as instrumentation objectives and design. The structural-health monitoring component of the project, including data retrieval and processing, damage detection and localization, automated alerting system, and finally data dissemination, will be presented in a separate report.

  16. Infertility Care Among OEF/OIF/OND Women Veterans in the Department of Veterans Affairs

    Science.gov (United States)

    Mattocks, Kristin; Kroll-Desrosiers, Aimee; Zephyrin, Laurie; Katon, Jodie; Weitlauf, Julie; Bastian, Lori; Haskell, Sally; Brandt, Cynthia

    2015-01-01

    Background An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care. Methods We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)—Contingency Tracking System Deployment file of military discharges from October 1, 2001–December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes. Results Less than 2% (n = 1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers. Conclusions Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women’s use of VA infertility services is an important component of understanding VA

  17. Infertility care among OEF/OIF/OND women Veterans in the Department of Veterans Affairs.

    Science.gov (United States)

    Mattocks, Kristin; Kroll-Desrosiers, Aimee; Zephyrin, Laurie; Katon, Jodie; Weitlauf, Julie; Bastian, Lori; Haskell, Sally; Brandt, Cynthia

    2015-04-01

    An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care. We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)-Contingency Tracking System Deployment file of military discharges from October 1, 2001-December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes. Less than 2% (n=1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers. Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women's use of VA infertility services is an important component of understanding VA's commitment to comprehensive medical care for

  18. Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration.

    Science.gov (United States)

    Burkhart, Lisa; Sohn, Min-Woong; Jordan, Neil; Tarlov, Elizabeth; Gampetro, Pamela; LaVela, Sherri L

    2016-01-01

    The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement. This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease. Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site. Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.

  19. Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

    Science.gov (United States)

    Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

    2012-01-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

  20. Medication wrong route administration: a poisons center-based study.

    Science.gov (United States)

    Bloch-Teitelbaum, Alexandra; Lüde, Saskia; Rauber-Lüthy, Christine; Kupferschmidt, Hugo; Russmann, Stefan; Kullak-Ublick, Gerd A; Ceschi, Alessandro

    2013-03-01

    To describe clinical effects, circumstances of occurrence, management and outcomes of cases of inadvertent administration of medications by an incorrect parenteral route. Retrospective single-center consecutive review of parenteral route errors of medications, reported to our center between January 2006 and June 2010. We collected demographic data and information on medications, route and time of administration, severity of symptoms/signs, treatment, and outcome. Seventy-eight cases (68 adults, 10 children) were available for analysis. The following wrong administration routes were recorded: paravenous (51%), intravenous (33%), subcutaneous (8%), and others (8%). Medications most frequently involved were iodinated x-ray contrast media (11%) and iron infusions (9%). Twenty-eight percent of the patients were asymptomatic and 54% showed mild symptoms; moderate and severe symptoms were observed in 9% and 7.7%, respectively, and were mostly due to intravenous administration errors. There was no fatal outcome. In most symptomatic cases local nonspecific treatment was performed. Enquiries concerning administration of medicines by an incorrect parenteral route were rare, and mainly involved iodinated x-ray contrast media and iron infusions. Most events occurred in adults and showed a benign clinical course. Although the majority of exposures concerned the paravenous route, the occasional severe cases were observed mainly after inadvertent intravenous administration.

  1. Molecular epidemiology of carbapenem non-susceptible Acinetobacter nosocomialis in a medical center in Taiwan.

    Science.gov (United States)

    Yang, Ya-Sung; Lee, Yi-Tzu; Wang, Yung-Chih; Chiu, Chun-Hsiang; Kuo, Shu-Chen; Sun, Jun-Ren; Yin, Ti; Chen, Te-Li; Lin, Jung-Chung; Fung, Chang-Phone; Chang, Feng-Yee

    2015-04-01

    The mechanism by which carbapenem non-susceptible Acinetobacter nosocomialis (CNSAN) is disseminated is rarely described in the literature. In this study, we delineated the molecular epidemiology of CNSAN isolated from patients in a medical center in Taiwan. Fifty-four non-duplicate bloodstream isolates of CNSAN were collected at the Taipei Veterans General Hospital between 2001 and 2007. Pulsed-field gel electrophoresis (PFGE) was performed to determine their clonal relationship. Carbapenem-resistance genes and associated genetic structures were detected by polymerase chain reaction (PCR) mapping. Southern hybridization was performed to determine the plasmid location of carbapenem-resistance genes. Transmissibility of these genes to Acinetobacterbaumannii was demonstrated by conjugation tests. The overall carbapenem non-susceptibility rate among A. nosocomialis isolates during the study period was 21.6% (54/250). PFGE revealed three major pulsotypes: H (n=23), I (n=10), and K (n=8). The most common carbapenem-resistance gene was blaOXA-58 (43/54, 79.6%), containing an upstream insertion sequence IS1006 and a truncated ISAba3 (IS1006-ΔISAba3-like-blaOXA-58). All isolates belonging to the pulsotypes H, I, and K carried plasmid located IS1006-ΔISAba3-like-blaOXA-58. A common plasmid carrying ISAba1-blaOXA-82 was found in six isolates, which belonged to five pulsotypes. A type 1 integron that carried blaIMP-1 was detected in different plasmids of seven isolates, which belonged to five pulsotypes. Plasmids carrying these carbapenem-resistant determinants were transmissible from A. nosocomialis to A. baumannii via conjugation. In this medical center, CNSAN mainly emerged through clonal dissemination; propagation of plasmids and integrons carrying carbapenem-resistant determinants played a minor role. This study showed that plasmids carrying carbapenem-resistant determinants are transmissible from A. nosocomialis to A. baumannii. Copyright © 2015 Elsevier B.V. All

  2. An Analysis of Medication Errors at the Military Medical Center: Implications for a Systems Approach for Error Reduction

    National Research Council Canada - National Science Library

    Scheirman, Katherine

    2001-01-01

    An analysis was accomplished of all inpatient medication errors at a military academic medical center during the year 2000, based on the causes of medication errors as described by current research in the field...

  3. Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

    Directory of Open Access Journals (Sweden)

    Marzec LN

    2015-06-01

    Full Text Available Lucas N Marzec,1 Evan P Carey,1 Anne C Lambert-Kerzner,1 Eric J Del Giacco,2 Stephanie D Melnyk,3 Chris L Bryson,4 Ibrahim E Fahdi,2 Hayden B Bosworth,3 Fran Fiocchi,5 P Michael Ho11Division of Cardiology, Denver VA Medical Center, Denver, CO, USA; 2Department of Medicine, Little Rock VA Medical Center, Little Rock, AR, USA; 3Department of Medicine, Durham VA Medical Center, Durham, NC, USA; 4Department of Medicine, Puget Sound VA Medical Center, Seattle, WA, USA; 5American College of Cardiology, Washington, DC, USABackground: Patient nonadherence to cardiac medications following acute coronary syndrome (ACS is associated with increased risk of recurrent events. However, the prevalence of cognitive dysfunction and poor health literacy among ACS patients and their association with medication nonadherence are poorly understood.Methods: We assessed rates of cognitive dysfunction and poor health literacy among participants of a clinical trial that tested the effectiveness of an intervention to improve medication adherence in patients hospitalized with ACS. Of 254 patients, 249 completed the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R survey, an assessment of risk for poor literacy, and the St Louis University Mental Status (SLUMS exam, a tool assessing for neurocognitive deficits, during ACS hospitalization. We assessed if SLUMS or REALM-R scores were associated with medication adherence.Results: Based on SLUMS score, 14% of patients were categorized as having dementia, and 52% with mild neurocognitive disorder (MNCD. Based on REALM-R score of ≤6, 34% of patients were categorized as at risk for poor health literacy. There was no association between poor health literacy and medication nonadherence. Of those with MNCD, 35.5% were nonadherent, compared to 17.5% with normal cognitive function and 6.7% with dementia. In multivariable analysis, cognitive dysfunction was associated with medication nonadherence (P=0.007, mainly due to

  4. Increased Postdeployment Use of Medication for Common Mental Disorders in Danish Gulf War Veterans

    DEFF Research Database (Denmark)

    Nissen, Lars Ravnborg; Stoltenberg, Christian Ditlev Gabriel; Vedtofte, Mia Sadowa

    2017-01-01

    /hypnotic medication, and (3) number of postdeployment psychiatric contacts. The association between outcomes and GWVs status was studied by using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until December 31, 2014....... FINDINGS: GWVs had an elevated average risk over time for use of both types of medication compared with NV. For use of antidepressants the average hazard rate (HR) was 2.56, with 95% confidence interval (CI) = 2.04-3.21 (p medication the corresponding results were....... Incident use of anxiolytic/hypnotic medication was one and a half that of NV after 10 years, but nearly three times that of NV after 20 years. There was no difference in rate of postdeployment psychiatric contacts. DISCUSSION/IMPACT/RECOMMENDATIONS: The findings of increased use of antidepressants...

  5. The Absent Interpreter in Administrative Detention Center Medical Units.

    Science.gov (United States)

    Rondeau-Lutz, Murielle; Weber, Jean-Christophe

    2017-03-01

    The particular situation of the French administrative detention center (ADC) medical units appears to be an exemplary case to study the difficulties facing medical practice. Indeed, the starting point of our inquiry was an amazing observation that needed to be addressed and understood: why are professional interpreters so seldom requested in ADC medical units, where one would expect that they would be "naturally" present? Aiming to fully explore the meanings of the "absent interpreter", this article takes into account the possible meanings of this situation: the recourse to professional interpreters in France is far from expected given cumulative evidence of its benefits; perceptions of illegal immigrants and medical habitus itself may both hamper the use of a third party; the ADCs are a very stressful place for healthcare professionals, with conflicting missions, political issues enmeshed with medical goals, and heavy affective burden that may lead to self-protection. Silencing voices of suffering others might be seen as the hidden indecent truth of the "absent interpreter". These reflections open a window to a larger issue with regard to the full range of medicine: what are the place, the role and the function of patient's words and narratives in contemporary medicine? The highly invested somatic perspective and its political corollary giving primacy to bare life harbor potential risks of obscuring speeches and undervaluing narratives.

  6. Evaluation of patient centered medical home practice transformation initiatives.

    Science.gov (United States)

    Crabtree, Benjamin F; Chase, Sabrina M; Wise, Christopher G; Schiff, Gordon D; Schmidt, Laura A; Goyzueta, Jeanette R; Malouin, Rebecca A; Payne, Susan M C; Quinn, Michael T; Nutting, Paul A; Miller, William L; Jaén, Carlos Roberto

    2011-01-01

    The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices. Investigators participating in 9 different evaluations of Patient Centered Medical Home implementation shared experiences, methodological strategies, and evaluation challenges for evaluating primary care practice redesign. A year-long iterative process of sharing and reflecting on experiences produced consensus on 7 recommendations for future PCMH evaluations: (1) look critically at models being implemented and identify aspects requiring modification; (2) include embedded qualitative and quantitative data collection to detail the implementation process; (3) capture details concerning how different PCMH components interact with one another over time; (4) understand and describe how and why physician and staff roles do, or do not evolve; (5) identify the effectiveness of individual PCMH components and how they are used; (6) capture how primary care practices interface with other entities such as specialists, hospitals, and referral services; and (7) measure resources required for initiating and sustaining innovations. Broad-based longitudinal, mixed-methods designs that provide for shared learning among practice participants, program implementers, and evaluators are necessary to evaluate the novelty and promise of the PCMH model. All PCMH evaluations should as comprehensive as possible, and at a minimum should include a combination of brief observations and targeted qualitative interviews along with quantitative measures.

  7. Who is served by programs for the homeless? Admission to a domiciliary care program for homeless veterans.

    Science.gov (United States)

    Rosenheck, R; Leda, C

    1991-02-01

    Demographic and clinical data are presented on 4,138 veterans assessed in the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at risk for homelessness, and without public financial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.

  8. Civilian primary care prescribing psychologist in an army medical center.

    Science.gov (United States)

    Shearer, David S

    2012-12-01

    The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.

  9. A suicide prevention advisory group at an academic medical center.

    Science.gov (United States)

    Hough, David; Lewis, Philip

    2010-05-01

    During a 15-month period, there were seven suicides among patients who were in active treatment or who had been seen recently by providers in the Department of Psychiatry of Tripler Army Medical Center, Honolulu, Hawaii. As a result, a Suicide Prevention Advisory Group (SPAG) was formed to identify possible causes and make recommendations aimed at improving the identification and treatment of suicidal patients. The group made 11 specific recommendations. No known suicides occurred during the 22 months after the implementation of the Suicide Prevention Advisory Group's recommendations.

  10. Case study: a data warehouse for an academic medical center.

    Science.gov (United States)

    Einbinder, J S; Scully, K W; Pates, R D; Schubart, J R; Reynolds, R E

    2001-01-01

    The clinical data repository (CDR) is a frequently updated relational data warehouse that provides users with direct access to detailed, flexible, and rapid retrospective views of clinical, administrative, and financial patient data for the University of Virginia Health System. This article presents a case study of the CDR, detailing its five-year history and focusing on the unique role of data warehousing in an academic medical center. Specifically, the CDR must support multiple missions, including research and education, in addition to administration and management. Users include not only analysts and administrators but clinicians, researchers, and students.

  11. Patient-Centered Medical Home Capacity and Ambulatory Care Utilization.

    Science.gov (United States)

    Hearld, Larry R; Hearld, Kristine R; Guerrazzi, Claudia

    The patient-centered medical home (PCMH) has increasingly received attention as a model of care to potentially remedy the cost and quality problems that confront the US health care system, including and especially ambulatory care-related issues. This study examined the association between physician practices' PCMH capacity and 3 indicators of ambulatory care utilization: (1) emergency department utilization, (2) ambulatory care sensitive hospitalization rate, and (3) 30-day all-cause readmission rate. Results show that overall PCMH capacity is associated with lower rates, and technical aspects of the PCMH in particular were associated with lower utilization rates while interpersonal capabilities were not.

  12. Radiology engineering at the Albany Medical Center: five year's experience.

    Science.gov (United States)

    Hack, S N; Heiss, J; Martinichio, M J

    1987-01-01

    A Radiology Engineering program was initiated in the Department of Radiology at the Albany Medical Center, Albany, New York, in the summer of 1981. The program has been successful in attaining its goals of containing costs, providing minimal equipment downtime, and giving high-quality service. This report presents the job functions and duties that the department found necessary to provide this level of service. In addition, two techniques for managing malfunction and service reports, techniques for scheduling PM's and service calls, and software management tools that assist the department with service are described.

  13. A pharmacy's journey toward the patient-centered medical home.

    Science.gov (United States)

    Erickson, Steven; Hambleton, Jeffrey

    2011-01-01

    To describe the integration of a clinic pharmacy with a patient-centered medical home (PCMH). Primary care clinic in Monroe, WA, from 1981 to January 2011. Pharmacists and physicians with a previous working relationship in a family practice residency program established colocated practices in 1981. In addition to traditional pharmacy services, collaborative practice agreements were developed and clinical pharmacy services expanded over time. Reimbursement challenges for clinical pharmacy services existed in the fee-for-service environment. The acquisition of the clinic and pharmacy by Providence Health and Services created a new financial alignment with additional opportunities for collaboration. An internally funded grant established a PCMH pilot that included pharmacist participation. PCMH pharmacists and the care provider team identified areas to improve physician and clinic efficiencies and to enhance patient care. Clinical pharmacy services expanded under the PCMH model. Pharmacist activities included value-added refill authorization services, coordinated patient visits with the PCMH pharmacist and physicians, medication therapy management, diabetes and anticoagulation services, hospital discharge medication reconciliation, and participation in the shared medical appointment. Clinical pharmacy services are woven into the PCMH fabric of this clinic. New pharmacists will be challenged and rewarded in this evolving health care model.

  14. Missed diagnosis of psychotic depression at 4 academic medical centers.

    Science.gov (United States)

    Rothschild, Anthony J; Winer, Jesse; Flint, Alastair J; Mulsant, Benoit H; Whyte, Ellen M; Heo, Moonseong; Fratoni, Susan; Gabriele, Michelle; Kasapinovic, Sonja; Meyers, Barnett S

    2008-08-01

    Major depressive disorder with psychotic features (psychotic depression), though occurring relatively frequently in the general population, is a commonly missed psychiatric diagnosis. To ascertain accuracy of diagnosis of psychotic depression among inpatients at 4 academic medical centers and explore whether presenting symptoms, treatment setting, and physician's level of training affect the accuracy of diagnosis. The medical records of 65 patients who met DSM-IV criteria for psychotic depression following systematic assessment were analyzed to ascertain the concordance between chart diagnoses and research diagnoses arrived at using the Structured Clinical Interview for DSM-IV. The patients were participants in the National Institute of Mental Health Study of Pharmacotherapy of Psychotic Depression, conducted from December 28, 2002, through June 18, 2004, at 4 academic medical centers. For each patient's hospital visit, separate standardized data forms were completed on the basis of each physician's assessment of the patient prior to screening for the study. Hospital records from the emergency room and from admission to psychiatric units were reviewed. Among these 65 patients, 130 chart diagnoses had been made. Psychotic depression had not been diagnosed prior to research assessments for 27% of the 130 diagnoses in our sample. The 3 most common diagnoses assigned to patients meeting research criteria for psychotic depression were major depressive disorder without psychotic features, depression not otherwise specified, and mood disorder not otherwise specified. Failure to identify psychotic depression was more likely when symptoms of depressed mood, hallucinations, or delusions were not noted in the medical record (all p depression is frequently missed in emergency room and inpatient settings. The findings of this study are sobering given the serious morbidity and mortality of psychotic depression and the implications for treatment if an inaccurate diagnosis is made

  15. 78 FR 74163 - Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice...

    Science.gov (United States)

    2013-12-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Harrison Medical Center, a Subsidiary of Franciscan Health System... Adjustment Assistance (TAA), applicable to workers and former workers of Harrison Medical Center, a...

  16. Evaluation of Cholesterol as a Biomarker for Suicidality in a Veteran Sample.

    Science.gov (United States)

    Reuter, Chuck; Caldwell, Barbara; Basehore, Heather

    2017-08-01

    A reduction in total cholesterol may alter the microviscosity of the brain-cell-membrane, reducing serotonin receptor exposure. The resulting imbalance between serotonin and dopamine may lead to an increased risk for suicidality. The objective of this research was to evaluate total cholesterol as a biological marker for suicidality in a sample of US military veterans. The study population consisted of veterans who received care at the Coatesville Veterans Affairs Medical Center (VAMC) and were included in the Suicide Prevention Coordinator's database for having suicidal ideation with evidence of escalating intent, a documented suicide attempt, or committed suicide between 2009 and 2015. The veterans' medical data were obtained from the facility's computerized patient record system. The final sample was 188 observations from 128 unique veterans. Veterans with total cholesterol levels below 168 mg/dl appeared to have a higher suicide risk than those with higher levels. The cholesterol levels of veterans reporting suicidal ideation or attempt were significantly lower than the group reporting neither [F(2, 185) = 30.19, p cholesterol levels from an earlier visit in which they did not report suicidality. A latent class analysis revealed that among other differences, suicidal veterans were younger, leaner, and had more anxiety, sleep problems, and higher education than those being seen for an issue unrelated to suicidality. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. Challenges of Providing End-of-Life Care for Homeless Veterans.

    Science.gov (United States)

    Hutt, Evelyn; Whitfield, Emily; Min, Sung-Joon; Jones, Jacqueline; Weber, Mary; Albright, Karen; Levy, Cari; O'Toole, Thomas

    2016-05-01

    To describe challenges of caring for homeless veterans at end of life (EOL) as perceived by Veterans Affairs Medical Center (VAMC) homeless and EOL care staff. E-mail survey. Homelessness and EOL programs at VAMCs. Programs and their ratings of personal, structural, and clinical care challenges were described statistically. Homelessness and EOL program responses were compared in unadjusted analyses and using multivariable models. Of 152 VAMCs, 50 (33%) completed the survey. The VAMCs treated an average of 6.5 homeless veterans at EOL annually. Lack of appropriate housing was the most critical challenge. The EOL programs expressed somewhat more concern about lack of appropriate care site and care coordination than did homelessness programs. Personal, clinical, and structural challenges face care providers for veterans who are homeless at EOL. Deeper understanding of these challenges will require qualitative study of homeless veterans and care providers. © The Author(s) 2015.

  18. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G

    2011-10-01

    Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

  19. [The advantages of a large tertiary academic medical center in managing disease and promoting health: a glimpse into Sheba Medical Center].

    Science.gov (United States)

    Segal, Gad; Zimlichman, Eyal

    2015-02-01

    Academic medical centers have traditionally been at the forefront of medical training for the next generation of clinicians, providing the highest quality of care and conducting translational and clinical research. The Sheba Medical Center is the largest academic medical center in Israel and, as such, has been shaping the medical scene in Israel since the birth of the State. The cornerstones of the Sheba Medical Center have always brought together the best clinicians, fostering a multidisciplinary approach environment, encouraging research and innovation from lab to bedside and compassionate, patient-centered care. Clinicians at Sheba enjoy the wide variety of clinical conditions that are present at the hospital, the existence of multiple professions and specialties from neonates to geriatric rehabilitation and the advanced technologies available to patients. In this special issue we describe some of the important work that takes place at Sheba, while emphasizing the above-mentioned advantages.

  20. Publications in academic medical centers: technology-facilitated culture clash.

    Science.gov (United States)

    Berner, Eta S

    2014-05-01

    Academic culture has a set of norms, expectations, and values that are sometimes tacit and sometimes very explicit. In medical school and other health professions educational settings, probably the most common norm includes placing a high value on peer-reviewed research publications, which are seen as the major evidence of scholarly productivity. Other features of academic culture include encouraging junior faculty and graduate students to share their research results at professional conferences and lecturing with slides as a major way to convey information. Major values that faculty share with journal editors include responsible conduct of research and proper attribution of others' words and ideas. Medical school faculty also value technology and are often quick to embrace technological advances that can assist them in their teaching and research. This article addresses the effects of technology on three aspects of academic culture: education, presentations at professional meetings, and research publications.The technologies discussed include online instruction, dissemination of conference proceedings on the Internet, plagiarism-detection software, and new technologies deployed by the National Center for Biotechnology Information, the home of PubMed. The author describes how the ease of deploying new technologies without faculty changing their norms and behavior in the areas of teaching and research can lead to conflicts of values among key stakeholders in the academic medical community, including faculty, journal editors, and professional associations. The implications of these conflicts and strategies for managing them are discussed.

  1. Are non-allergic drug reactions commonly documented as medication "allergies"? A national cohort of Veterans' admissions from 2000 to 2014.

    Science.gov (United States)

    McConeghy, Kevin W; Caffrey, Aisling R; Morrill, Haley J; Trivedi, Amal N; LaPlante, Kerry L

    2017-04-01

    Adverse drug reactions (ADRs) including medication allergies are not well-described among large national cohorts. This study described the most common documented medication allergies and their reactions among a national cohort of Veterans Affairs (VA) inpatients. We evaluated inpatient admissions in any VA Medical Center from 1 January 2000 to 31 December 2014. Each admission was linked with allergy history preceding or upon admission. Individual drugs were aggregated into drug class category including: penicillins, sulfonamides, angiotensin converting enzyme (ACE) inhibitors, opiates, HMG-CoA reductase inhibitors ("statins") and non-steroidal anti-inflammatory inhibitors (NSAID). Results were reported in aggregate and over time. Approximately ~10.8 million inpatient admissions occurred from 2000 to 2014. We found the most commonly reported allergy drug classes were penicillins (13%, n = 1 410 080), opiates (9.1%, n = 984 978), ACE inhibitors (5.7%, n = 618 075) sulfonamides (5.1%, n = 558 653), NSAIDs (5.1%, n = 551 216) and statins (3.6%, n = 391 983). Several allergy histories increased over time including opiates (6.2 to 11.2%), ACE inhibitors (1.3 to 10.2%), statins (0.3 to 7.3%) and NSAIDs (3.9 to 6.0%). Rash was the most commonly documented reaction on reports for penicillins (25.5%, n = 371 825), sulfonamides (25.6%, n = 165 954) and NSAIDs (10.3%, n = 65 741). The most common reaction for opiates was nausea/vomiting (17.9%, n = 211 864), cough/coughing for ACE inhibitors (41.0%, n = 270 537) and muscle pain/myalgia for statins (34.1%, n = 186 565). We report that penicillins and opiates are the most commonly documented drug allergies among VA inpatients, but other drug classes such as ACE inhibitors, statins and NSAIDs are becoming increasingly common. Clinicians also commonly document non-allergic ADRs in the allergy section such as cough or myalgia. Copyright © 2016 John Wiley

  2. Consolidated Copayment Processing Center (CCPC)

    Data.gov (United States)

    Department of Veterans Affairs — The Consolidated Copayment Processing Center (CCPC) database contains Veteran patient contact and billing information in order to support the printing and mailing of...

  3. Access to Care Among Nonelderly Veterans.

    Science.gov (United States)

    Bernard, Didem M; Selden, Thomas M

    2016-03-01

    Veteran access to care is an important policy issue that has not previously been examined with population-based survey data. This study compares access to care for nonelderly adult Veterans versus comparable non-Veterans, overall and within subgroups defined by simulated eligibility for health care from the Veterans Health Administration and by insurance status. We use household survey data from the Medical Expenditure Panel Survey from 2006 to 2011. We use iterative proportional fitting to standardize (control for) differences in age, sex, income, medical conditions, disability, Census region, and Metropolitan Statistical Area. Nonelderly Veterans and comparable non-Veterans. For medical, dental, and prescription medicine treatments, we use 4 access measures: delaying care, inability to obtain care, perceiving delay as a big problem, and perceiving inability to obtain care as a big problem. We also examine having a usual source of care. Frequencies of access barriers are similar for nonelderly Veterans and comparable non-Veterans for dental and prescription medicine treatments. For medical treatment, we find that Veterans eligible for VA health care and Veterans with VA use who are uninsured report fewer access problems than the comparable non-Veteran populations for 2 measures: inability to obtain care and reporting inability to obtain care as a big problem. Our results show that uninsured Veterans, the most policy-relevant group, have better access to care than comparable non-Veterans. Our results highlight the importance of adjusting Veteran and non-Veteran comparisons to account for the higher than average health care needs of Veterans.

  4. Veterans Benefits: Burial Benefits and National Cemeteries

    Science.gov (United States)

    2010-10-18

    hospital, nursing home, or domiciliary care facility; and (2) a plot allowance for a veteran eligible for burial in a national cemetery who is not... domiciliary care . The VA was permitted to enter into contracts to provide the burial and funeral services for veterans who died in VA facilities...Veterans Affairs (VA) provides a range of benefits and services to veterans who meet certain eligibility rules; benefits include hospital and medical care

  5. A VA medical center's PTSD residential recovery program.

    Science.gov (United States)

    Devaney, Donald E

    2010-01-01

    With the influx of military veterans with Post Traumatic Stress Disorder (PTSD) increasingly affecting all healthcare facilities, including acute care and long term, learning from the experience of VA hospitals in treating those with PTSD may prove valuable. In this article, Tripler/VA Provost Marshal Donald E. Delaney describes a program that has been in operation since 1994. He may be contacted for further in formation at (808) 433-4465 or Donald.devaney@amedd.army .mil

  6. Do medical residents perform patient-centered medical home tasks? A mixed-methods study

    OpenAIRE

    Block, Lauren; LaVine, Nancy; Verbsky, Jennifer; Sagar, Ankita; Smith, Miriam A.; Lane, Susan; Conigliaro, Joseph; Chaudhry, Saima A.

    2017-01-01

    ABSTRACT Background: Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice. Objective: To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites. Design: Survey and nominal group data from post-graduate trainees at three residency programs. Results: A to...

  7. Evaluation of US Veterans Nutrition Education for Diabetes Prevention.

    Science.gov (United States)

    Erickson, Megan; Braun, Katie; List, Riesa; Utech, Anne; Moore, Carolyn; White, Donna L; Garcia, Jose M

    2016-09-01

    Evaluate the effectiveness of nutrition education interventions for diabetes prevention. Retrospective cohort design. Tertiary-care US Veterans' Hospital, July 2007 to July 2012, using pre-existing database. Prediabetic, adult veterans (n = 372), mostly men (94.4%, n = 351). Visits with existing nutrition education classes were collected. diabetes status; predictors: visits/encounters, age, body mass index, weight change, and hemoglobin A1c. Cox proportional hazards method, χ(2) test, and logistic regression. In this sample, prediabetic veterans who received nutrition education were less likely to develop diabetes when compared with prediabetic veterans who did not receive nutrition education (hazard ratio, 0.71; 95% confidence interval, 0.55-0.92; P Nutrition education was significantly associated with preventing the progression from prediabetes to diabetes in US Veterans participating in a nutrition education intervention at the Michael E. DeBakey Veterans Affairs Medical Center. Copyright © 2016 Society for Nutrition Education and Behavior. All rights reserved.

  8. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There Show You ... more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from Veterans ...

  9. Do medical residents perform patient-centered medical home tasks? A mixed-methods study.

    Science.gov (United States)

    Block, Lauren; LaVine, Nancy; Verbsky, Jennifer; Sagar, Ankita; Smith, Miriam A; Lane, Susan; Conigliaro, Joseph; Chaudhry, Saima A

    2017-01-01

    Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice. To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites. Survey and nominal group data from post-graduate trainees at three residency programs. A total of 179 residents responded (80% response). Over half (52%) cared for patients at PCMH sites. Residents at PCMH sites were more likely to report engaging in tasks in the NCQA domains of enhancing access and continuity (p office inefficiencies as barriers to care. Residents trained at PCMH sites were more likely to engage in tasks in several NCQA domains, but not care coordination and quality assessment. Similar facilitators and barriers to trainee provision of patient-centered care were cited regardless of PCMH status. Curricula on PCMH principles and workflows that foster continuity and communication may help to inform residents on PCMH tenets and incorporate residents into team-based care. EPA: Entrustable professional activity; GIM: General Internal Medicine; NCQA: National Center for Quality Assurance; PCMH: Patient-centered medical home.

  10. A nationwide survey of patient centered medical home demonstration projects.

    Science.gov (United States)

    Bitton, Asaf; Martin, Carina; Landon, Bruce E

    2010-06-01

    The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Cross-sectional key-informant interviews. Leaders from existing PCMH demonstration projects with external payment reform. We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified--consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

  11. Impact of a patient-centered medical home clerkship curriculum.

    Science.gov (United States)

    Collins, Lauren; Sato, Rino; LaNoue, Marianna; Michaluk, Lisa; Verma, Manisha

    2014-06-01

    The purpose of this study was to assess the impact of a patient-centered medical home (PCMH) curriculum introduced in a family medicine clerkship in 2011--2012. This new curriculum introduced third-year students to the PCMH using a variety of interactive educational formats, including case-based, online, and experiential PCMH activities. Qualitative analysis of student reflection essays explored themes based on PCMH experiences during family medicine clerkships. Pre-curricular needs assessment revealed an important gap in students' exposure to and knowledge of PCMH concepts consistent with existing literature. Qualitative thematic analysis examined students' perceptions of patient experiences in PCMH practices but also revealed rich, unprompted, and very positive perceptions of student and provider roles and system-based changes in the PCMH model. Only 2.3% of coded references (n=10, out of 435) described "negative" emotional reactions to PCMH experiences. More than half of student essays described important changes in self-assessed knowledge, skills, and attitudes, another significant and unexpected result. Successful implementation of innovative PCMH curricula is key to preparing a workforce ready to practice in a new model of health care delivery. This qualitative study demonstrates that an experiential PCMH curriculum can enhance third-year medical student self-assessed knowledge of and attitudes toward the PCMH and may improve perceptions of a career in primary care.

  12. Early evaluation of MDIS workstations at Madigan Army Medical Center

    Science.gov (United States)

    Leckie, Robert G.; Goeringer, Fred; Smith, Donald V.; Bender, Gregory N.; Choi, Hyung-Sik; Haynor, David R.; Kim, Yongmin

    1993-06-01

    The image viewing workstation is an all-important link in the PACS (Picture Archiving and Communications System) chain since it represents the interface between the system and the user. For PACS to function, the working environment and transfer of information to the user must be the same or better than the traditional film-based system. The important characteristics of a workstation from a clinical standpoint are acceptable image quality, rapid response time, a friendly user interface, and a well-integrated, highly-reliable, fault-tolerant system which provides the user ample functions to complete his tasks successfully. Since early 1992, the MDIS (Medical Diagnostic Imaging Support) system's diagnostic and clinical workstations have been installed at Madigan Army Medical Center. Various functionalities and performance characteristics of the MDIS workstations such as image display, response time, database, and ergonomics will be presented. User comments and early experience with the workstations as well as new functionality recommended for the future will be discussed.

  13. VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans

    Science.gov (United States)

    2016-12-01

    that VA medical centers complied with requirements related to the environment of care for women veterans and VHA’s oversight of that compliance; (2...VHA’s oversight of medical facilities’ compliance with these requirements; 2. what is known about the availability of VHA medical providers who can...site visits cannot be generalized to other VAMCs. To examine VHA’s oversight of medical facilities’ compliance with requirements related to the

  14. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Us FAQs Ask a Question Toll Free Numbers Homeless Veterans Chat VA » Health Care » PTSD: National Center for ... Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans Seniors & Aging Veterans ...

  15. Spectrum of tablet computer use by medical students and residents at an academic medical center

    Directory of Open Access Journals (Sweden)

    Robert Robinson

    2015-07-01

    Full Text Available Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians.Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM in July and August of 2012.Results. There were 76 medical student responses (26% response rate and 66 resident/fellow responses to this survey (21% response rate. Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035. The most common reported uses were for accessing medical reference applications (46%, e-Books (45%, and board study (32%. Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010, review radiology images (27% vs. 12%, p = 0.019, and enter patient care orders (26% vs. 3%, p < 0.001.Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks.Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on

  16. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Home Apply for VA Care Apply Online Application Process Veteran Eligibility Active Duty Families of Veterans Women ... Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen ...

  17. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Active Duty Families of Veterans Women Veterans Determine Costs Copays Means Test Health Insurance Make a Payment ... Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen ...

  18. Patient-centered Medical Home Capability and Clinical Performance in HRSA-supported Health Centers

    Science.gov (United States)

    Shi, Leiyu; Lock, Diana C.; Lee, De-Chih; Lebrun-Harris, Lydie A.; Chin, Marshall H.; Chidambaran, Preeta; Nocon, Robert S.; Zhu, Jinsheng; Sripipatana, Alek

    2015-01-01

    Objectives To evaluate the relationship between Patient-centered Medical Home (PCMH) model adoption in health centers (HCs) and clinical performance measures and to determine if adoption of PCMH characteristics is associated with better clinical performance. Research Design Data came from the Health Resources and Services Administration’s 2009 Uniform Data System and the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers. Clinical performance measures included 2 process measures (childhood immunization and cervical cancer screening) and 2 outcome measures (hypertension control and diabetes control). Total and subscale PCMH scores were regressed on the clinical performance measures, adjusting for patient, provider, financial, and institutional characteristics. Results The findings showed different directional relationships, with some PCMH domains (care management, test/referral tracking, quality improvement, and external coordination) showing little or no effect on outcome measures of interest, 1 domain (access/communication) associated with improved outcomes, and 1 domain (patient tracking/registry) associated with worse outcomes. Conclusions This study is among the first to examine the association between PCMH transformation and clinical performance in HCs, providing an understanding of the impact of PCMH adoption within safety-net settings. The mixed results highlight the importance of examining relationships between specific PCMH domains and specific clinical quality measures, in addition to analyzing overall PCMH scores which could yield distorted findings. PMID:25793267

  19. Measuring patient-centered medical home access and continuity in clinics with part-time clinicians.

    Science.gov (United States)

    Rosland, Ann-Marie; Krein, Sarah L; Kim, Hyunglin Myra; Greenstone, Clinton L; Tremblay, Adam; Ratz, David; Saffar, Darcy; Kerr, Eve A

    2015-05-01

    Common patient-centered medical home (PCMH) performance measures value access to a single primary care provider (PCP), which may have unintended consequences for clinics that rely on part-time PCPs and team-based care. Retrospective analysis of 110,454 primary care visits from 2 Veterans Health Administration clinics from 2010 to 2012. Multi-level models examined associations between PCP availability in clinic, and performance on access and continuity measures. Patient experiences with access and continuity were compared using 2012 patient survey data (N = 2881). Patients of PCPs with fewer half-day clinic sessions per week were significantly less likely to get a requested same-day appointment with their usual PCP (predicted probability 17% for PCPs with 2 sessions/week, 20% for 5 sessions/week, and 26% for 10 sessions/week). Among requests that did not result in a same-day appointment with the usual PCP, there were no significant differences in same-day access to a different PCP, or access within 2 to 7 days with patients' usual PCP. Overall, patients had >92% continuity with their usual PCP at the hospital-based site regardless of PCP sessions/week. Patients of full-time PCPs reported timely appointments for urgent needs more often than patients of part-time PCPs (82% vs 71%; P Part-time PCP performance appeared worse when using measures focused on same-day access to patients' usual PCP. However, clinic-level same-day access, same-week access to the usual PCP, and overall continuity were similar for patients of part-time and full-time PCPs. Measures of in-person access to a usual PCP do not capture alternate access approaches encouraged by PCMH, and often used by part-time providers, such as team-based or non-face-to-face care.

  20. Status of Hepatitis B Immunization in Medical Stuffs at Children Medical Center Hospital-Tehran

    Directory of Open Access Journals (Sweden)

    M Najafi

    2014-04-01

    Full Text Available Introduction: Hepatitis B is a disease caused by the hepatitis B virus (HBV, which is transmitted through percutaneous (i.e., puncture through the skin or mucosal (i.e., direct contact with mucous membranes exposure to infectious blood or body fluids. HBV can cause chronic infection, resulting in cirrhosis of the liver, liver cancer, liver failure, and death. Persons with chronic infection also serve as the main reservoir for continued HBV transmission.   Material and Methods: This is a prospective cross sectional study was performed in Children Medical Center Hospital on 396 medical personals (including 172 students, 92 interns, 56 residents and 56 fellowships during September 2012 to October 2013.   Results: All of medical staff had done HB vaccination. In 93% of them the vaccination was complete. The others, 16% had only one, and 84% had two dose injections. 73% didn’t check HBsAb after vaccination.  Results showed in 21.4% of fellowships, 42.8% of residents, non of interns and 35% of students, had checked HBsAb.   Conclusion: Hepatitis B is a vaccine-preventable disease. HB is a serious world wide infection and medical staff are one of the most high risk groups. So Vaccinate their and HBS Antibody titer determination after complete vaccination is mandatory.    Keywords:Immunization, Hepatitis B, Medical Staff, Vaccination.  

  1. Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home.

    Science.gov (United States)

    Flieger, Signe Peterson

    This study explores the implementation experience of nine primary care practices becoming patient-centered medical homes (PCMH) as part of the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot. The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the PCMH model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. Eighty-three interviews were conducted with administrative and clinical staff at the nine pilot practices, payers, and conveners of the pilot between November and December 2011. The interviews were transcribed, coded, and analyzed using both a priori and emergent themes. Although there is value in the structural components of the PCMH (e.g., disease registries), these structures are not enough. Becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration. This can be facilitated by settings aside time for communication and relationship building through structured meetings about PCMH components as well as the implementation process itself. Moreover, team-based care offers a robust opportunity to move beyond the structures to focus on relationships and collaboration. (a) Recognize that PCMH implementation is not a linear process. (b) Implementing the PCMH from a structural perspective is not enough. Although the National Committee for Quality Assurance or other guidelines can offer guidance on the structural components of PCMH implementation, this should serve only as a starting point. (c) During implementation, set aside structured time for reflection and sensemaking. (d) Use team-based care as a cornerstone of transformation. Reflect on team structures and also interactions of the team members. Taking the time to reflect will facilitate greater sensemaking and learning and

  2. Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration.

    Science.gov (United States)

    Miller, Edward Alan; Gidmark, Stefanie; Gadbois, Emily; Rudolph, James L; Intrator, Orna

    2017-06-21

    Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA). Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs). VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans' homes and families was a major factor in NH choice. Other key considerations included Veterans' specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, décor) often outweighed objective quality indicators in Veteran and family decision making. Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available.

  3. Eating disorders and associated mental health comorbidities in female veterans.

    Science.gov (United States)

    Mitchell, Karen S; Rasmusson, Ann; Bartlett, Brooke; Gerber, Megan R

    2014-11-30

    Eating disorders (EDs) remain understudied among veterans, possibly due to the perception that primarily male population does not suffer from EDs. However, previous research suggests that male and female veterans do experience EDs. The high rates of posttraumatic stress disorder (PTSD), depression, and obesity observed among veterans may make this group vulnerable to disordered eating. Retrospective chart review was used to obtain data from 492 female veterans who were presented to a women's primary care center at a large, urban VA medical center between 2007 and 2009. A total of 2.8% of this sample had been diagnosed with an ED. In bivariate analyses, presence of PTSD and depression were significantly associated with having an ED diagnosis. However, when these two disorders were included in a multivariate model controlling for age, only depression diagnosis and lower age were significantly related to ED status. In sum, the rate of EDs in this sample is comparable to prevalence estimates of EDs in the general population. Current findings underscore the importance of assessing for EDs among VA patients and the need for further research among veterans. Published by Elsevier Ireland Ltd.

  4. Development and implementation of a comprehensive strategic plan for medical education at an academic medical center.

    Science.gov (United States)

    Schwartzstein, Richard M; Huang, Grace C; Coughlin, Christine M

    2008-06-01

    Despite their vital contributions to the training of future physicians, many academic teaching hospitals have grown operationally and financially distinct from affiliated medical schools because of divergent missions, contributing to the erosion of clinical training. Some institutions have responded by building hybrid organizations; others by creating large health care networks with variable relationships with the affiliated medical school. In this case, the authors wished to establish the future educational mission of their medical center as a core element of the institution by creating data-driven recommendations for reorganization, programs, and financing. They conducted a self-study of all constituents, the results of which confirmed the importance of education at their institution but also revealed the insufficiency of incentives for teaching. They underwent an external review by a committee of prominent educators, and they involved administrators at the hospital and the medical school. Together, these inputs composed an informed assessment of medical education at their teaching hospital, from which they developed and actualized an institution-wide strategic plan for education. Over the course of three years, they centralized the administrative structure for education, implemented programs that cross departments and reinforce the UME-GME continuum, and created transparency in the financing of medical education. The plan was purposefully aligned with the clinical and research strategic plans by supporting patient safety in programs and the professional development of faculty. The application of a rigorous strategic planning process to medical education at an academic teaching hospital can focus the mission, invigorate faculty, and lead to innovative programs.

  5. Gynecologic evaluation of the first female soldiers enrolled in the Gulf War Comprehensive Clinical Evaluation Program at Tripler Army Medical Center.

    Science.gov (United States)

    Wittich, A C

    1996-11-01

    Tripler Army Medical Center initiated the Department of Defense's Persian Gulf Illness Comprehensive Clinical Evaluation Program (CCEP) on June 15, 1994. In the first 5 months, 100 patients enrolled in this program. Sixteen (16%) were women who served in the Persian Gulf during Desert Shield/ Desert Storm, and 1 (1%) was the dependent wife of a Gulf War veteran who is experiencing illness that may be related to the Persian Gulf War. All 17 women enrolled in the CCEP were evaluated in the Tripler Army Medical Center Obstetrics and Gynecology Clinic between June 17 and November 10, 1994. Each patient underwent gynecologic history, pelvic exam, Pap smear, and screen for fecal occult blood. Ten patients underwent baseline mammograms and 13 patients underwent urogenital and cervical cultures for aerobic bacteria, chlamydia and herpes simplex. The 1 patient with an abnormal Pap smear underwent cervical and endocervical biopsies and colposcopy (histology demonstrated no dysplasia or neoplasia). Half of the 16 Gulf War veterans experienced gynecologic problems while serving in the Gulf and 43% admitted gynecologic problems since returning in 1991. Of 6 patients who became pregnant after returning, 5 had normal pregnancies and 1 suffered four miscarriages.

  6. Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center.

    Science.gov (United States)

    Repplinger, Michael D; Weber, Andrew C; Pickhardt, Perry J; Rajamanickam, Victoria P; Svenson, James E; Ehlenbach, William J; Westergaard, Ryan P; Reeder, Scott B; Jacobs, Elizabeth A

    2016-09-01

    To quantify the trends in imaging use for the diagnosis of appendicitis. A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis. Medical record data extraction of these patients included imaging test used (ultrasound, CT, or MRI), gender, age, and body mass index (BMI). The proportion of patients undergoing each scan was calculated by year. Regression analysis was performed to determine whether age, gender, or BMI affected imaging choice. The study included a total of 2,108 patients, including 967 (43.5%) females and 599 (27%) children (use increased over time for the entire cohort (2.9% to 82.4%, P use increased more in females and adults than in males and children, but differences in trends were not statistically significant (male versus female, P = .8; adult versus child, P = .1). The percentage of patients who had no imaging used for the diagnosis of appendicitis decreased over time (P use of ultrasound or MRI over the study period. With increasing BMI, CT was more frequently used. Of those diagnosed with appendicitis at an academic medical center, CT use increased more than 20-fold. However, no statistically significant trend was found for increased use of ultrasound or MRI. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  7. Veterans Affairs Information Technology: Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems

    Science.gov (United States)

    2017-02-07

    Consolidate Data Centers, and Retire Legacy Systems Statement of Statement of David A. Powner, Director Information Technology Management Issues...Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems What GAO Found GAO...department had not assessed user satisfaction, or established user satisfaction goals. In addition, VA’s consolidation and closure of data centers

  8. Center takes hard line with press. The missing infant incident at Columbia Trident Medical Center.

    Science.gov (United States)

    Moore, P L

    1997-01-01

    When the body of a stillborn infant went missing from the Columbia Trident morgue, the press pounced. The hospital was accused of everything from neglect to a police-protected cover-up. Reporters stopped patients in the parking lot to ask them if they felt safe. Others used the incident to question Columbia's proposed merger with the local university medical center. In response, Columbia Trident initiated a strict policy that prohibits the press from showing up unannounced and stridently protects the rights of patients and employees. The case provokes questions about the role of public relations professionals in an age of sensationalism. When is withholding information justified and when is it an obstruction of justified inquiry? How far is too far for the press?

  9. Tobacco use among Iraq- and Afghanistan-era veterans: a qualitative study of barriers, facilitators, and treatment preferences.

    Science.gov (United States)

    Gierisch, Jennifer M; Straits-Tröster, Kristy; Calhoun, Patrick S; Beckham, Jean C; Acheson, Shawn; Hamlett-Berry, Kim

    2012-01-01

    Military service and combat exposure are risk factors for smoking. Although evidence suggests that veterans are interested in tobacco use cessation, little is known about their reasons for quitting, treatment preferences, and perceived barriers to effective tobacco use cessation treatment. Our study objective was to elicit perspectives of Iraq- and Afghanistan-era veterans who had not yet quit smoking postdeployment to inform the development of smoking cessation services for this veteran cohort. We conducted 3 focus groups among 20 participants in October 2006 at the Durham Veterans Affairs Medical Center to explore issues on tobacco use and smoking cessation for Iraq- and Afghanistan-era veterans who continued to smoke postdeployment. We used qualitative content analysis to identify major themes and organize data. Veterans expressed the belief that smoking was a normalized part of military life and described multiple perceived benefits of smoking. Although veterans expressed a high level of interest in quitting, they listed several behavioral, situational, and environmental triggers that derailed smoking cessation. They expressed interest in such cessation treatment features as flexible scheduling, free nicotine replacement therapy, peer support, and family inclusion in treatment. Our results indicate that the newest cohort of veterans perceives smoking as endemic in military service. However, they want to quit smoking and identified several personal and environmental obstacles that make smoking cessation difficult. Our findings may inform programmatic efforts to increase successful quit attempts in this unique veteran population.

  10. Veterans' homecomings

    DEFF Research Database (Denmark)

    Sørensen, Birgitte Refslund

    2015-01-01

    social identity and find a meaningful life in the civilian world. When doing so, they need to navigate an ambiguous political environment and emergent public imaginaries of the veteran while also wrestling with their own military socialization and personal experiences of war. The certainty previously...... experiences, present conditions, and future ambitions are embedded in webs of concealment, disclosure, exposure, deception, lying, silence, and so forth, only partially controlled by the veterans themselves. The intricacies and anxieties associated with secrecy work are discussed in relation to three veteran...

  11. Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH

    Directory of Open Access Journals (Sweden)

    Donald L. Uden, PharmD, FCCP

    2013-01-01

    Full Text Available Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH in the state of Minnesota. Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state. Results: The final analysis included 21 respondents. Size, setting, and time as a certified PCMH varied between practices. PCMHs reported a higher percentage of patients enrolled at lower complexity tiers (35.0 percent at tier I and 40.4 percent enrolled at tier II, with PCMHs with clinical pharmacist services reporting slightly increased frequency of higher complexity patients. The composition of the care team varied from clinic to clinic, but all clinics were multidisciplinary with a mean of 5.8 different provider types listed for each clinic. Physicians were the most common providers of medication management across all settings, and one respondent reported that medication management services are not formally provided in his/her clinic. The presence or absence of a clinical pharmacist did not significantly influence care coordination time dedicated to medication-related activities. Respondents residing in a clinic with clinical pharmacist services reported a high level of satisfaction with pharmacist-provided services. Conclusion: The implementation of the PCMH model in many of the participating clinics was relatively recent and there remains much to be learned regarding the landscape of comprehensive medication management in the PCMH. The reported distribution of patients in complexity tiers suggests that clinics may use different strategies to determine resource allocation. Although the presence of a clinical pharmacist did not influence care coordination time dedicated, care coordinators valued services

  12. Deficits in allergy knowledge among physicians at academic medical centers.

    Science.gov (United States)

    Stukus, David R; Green, Todd; Montandon, Shari V; Wada, Kara J

    2015-07-01

    Allergic conditions have high prevalence in the general population. Misconceptions regarding the diagnosis and management of allergic disease among physicians can lead to suboptimal clinical care. To determine the extent of allergy-related knowledge deficits among physicians. Pediatric and internal medicine resident and attending physicians from 2 separate academic medical centers were asked to answer an anonymous electronic survey. Survey questions addressed 7 different allergy content areas. Four hundred eight physicians completed surveys (23.9% response rate). Respondents had few correct answers (mean ± SD 1.91 ± 1.43). Pediatric respondents had a larger number of correct answers compared with medicine-trained physicians (P immunology elective correlated with a larger number of correct responses (P pediatric and internal medicine physicians and across all levels of training and specialty. Given the prevalence of allergic conditions, the potential implications of a negative impact on clinical care are staggering. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  13. Strategic groups and performance differences among academic medical centers.

    Science.gov (United States)

    Schreyögg, Jonas; von Reitzenstein, Constantin

    2008-01-01

    The performance of academic medical centers (AMCs) differs from that of other hospitals because AMCs must combine the delivery of patient care with teaching and research. : This study investigates the effects of strategic group membership as opposed to other structural determinants on the performance of AMCs. We used data from 24 German AMCs and applied data envelopment analysis with superefficiency to measure the performance of AMCs by considering AMC-specific inputs and outputs for patient care, teaching, and research. We used cluster analysis to identify strategic groups and applied regression analysis to explore their impact on performance. Our results reveal two strategic groups based on a specialization either in teaching or in research. The strategic group that specialized in research showed significantly better performance; structural variables did not play a major role. The results provide an important justification for managers to develop suitable strategic concepts for AMCs. If low organizational efficiency is detected, managers need to consider analyzing whether their AMC belongs to an appropriate strategic group. An emphasis on research may increase overall efficiency.

  14. Mental Health Recovery in the Patient-Centered Medical Home.

    Science.gov (United States)

    Sklar, Marisa; Aarons, Gregory A; O'Connell, Maria; Davidson, Larry; Groessl, Erik J

    2015-09-01

    We examined the impact of transitioning clients from a mental health clinic to a patient-centered medical home (PCMH) on mental health recovery. We drew data from a large US County Behavioral Health Services administrative data set. We used propensity score analysis and multilevel modeling to assess the impact of the PCMH on mental health recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU; n = 22,394) from 2011 to 2013 in San Diego County, California. We repeatedly assessed mental health recovery over time (days since baseline assessment range = 0-1639; mean = 186) with the Illness Management and Recovery (IMR) scale and Recovery Markers Questionnaire. For total IMR (log-likelihood ratio χ(2)[1] = 4696.97; P mental health recovery over time were greater for PCMH than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. Greater increases in mental health recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more widespread adoption of the PCMH.

  15. Cultural Awareness Among Nursing Staff at an Academic Medical Center.

    Science.gov (United States)

    McElroy, Jennifer; Smith-Miller, Cheryl A; Madigan, Catherine K; Li, Yin

    2016-03-01

    The goal is to identify areas for targeted improvement in regard to cultural awareness and competence among nursing staff and in the work environment. Many facilities have initiated programs to facilitate cultural competence development among nursing staff; however, there has been little examination of the effect of these initiatives, assessment of experienced nurses' cultural awareness, or investigation of nurse leader's role in promoting cultural competence in the literature. In this cross-sectional descriptive study, a cultural awareness survey was modified and electronically distributed to all registered nurses and assistive personnel at an academic medical center. The modified survey instrument showed good reliability and validity among the study population. Most nursing staff exhibited a moderate to high level of cultural awareness and held positive opinions about nursing leadership and the work environment with regard to cultural issues. In increasingly diverse work environments, assessing the cultural awareness of nursing staff enables nurse leaders to evaluate efforts in promoting cultural competence and to identify specific areas in which to target staff development efforts and leadership training.

  16. Status of Hepatitis B Immunization in Medical Stuffs at Children Medical Center Hospital-Tehran

    Directory of Open Access Journals (Sweden)

    Mehri Najafi

    2013-12-01

    Full Text Available Introduction: Hepatitis B is a disease caused by the hepatitis B virus (HBV, which is transmitted through percutaneous (i.e., puncture through the skin or mucosal (i.e., direct contact with mucous membranes exposure to infectious blood or body fluids. HBV can cause chronic infection, resulting in cirrhosis of the liver, liver cancer, liver failure, and death. Persons with chronic infection also serve as the main reservoir for continued HBV transmission.   Material and Methods: This is a prospective cross sectional study was performed in ChildrenMedicalCenterHospital on 396 medical personals (including 172 students,92 interns,56 residents and 56 fellowships during Sep 2012 to  Oct 2013. Results: All of medical staff had done HB vaccination. In 93% of them the vaccination was complete. The others,16% had only one, and 84% had two dose injections. 73% didn’t check HBsAb after vaccination.  Results showed in 21.4% of fellowships, 42.8% of residents, non of interns and 35% of students, had checked HBsAb.   Conclusion: Hepatitis B is a vaccine-preventable disease. HB is a serious world wide infection and medical staff are one of the most high risk groups. So Vaccinate their and HBS Antibody titer determination after complete vaccination is mandatory. 

  17. Analysis of Academic Medical Center Graduate Medical Education Websites for Policies Regarding Restrictive Covenants in Non-ACGME Fellowships.

    Science.gov (United States)

    Juern, Jeremy S; Stahl, David M; Weigelt, John A

    2017-10-25

    The topic of restrictive covenants in fellowships that are not approved by the Accreditation Council for Graduate Medical Education (ACGME) has not been studied. To investigate the presence of institutional polices at academic medical centers regarding restrictive covenants in non-ACGME fellowships. The graduate medical education (GME) office website of 132 academic medical centers was evaluated and searched for the following as of June 1, 2017: presence of any ACGME residency or fellowship, presence of any non-ACGME fellowship, presence of GME policies and procedures, presence of a restrictive covenant policy, and if that policy applies to non-ACGME fellowships. A total of 96 academic medical centers had non-ACGME fellowships. Of these, 56 prohibit restrictive covenants in non-ACGME fellowships because of either their GME policy or state law. Seven academic medical centers have a GME policy that allows restrictive covenants in non-ACGME fellowships. Two academic medical centers clearly state that fellows in a certain subspecialty fellowship will be required to sign a restrictive covenant. GME policies at academic medical centers that allow restrictive covenants in non-ACGME fellowships are very uncommon. The practice of having fellows sign a restrictive covenant in a non-ACGME fellowship is in conflict with an American Medical Association ethics statement, ACGME institutional requirement IV.L, and the rules of the San Francisco Match. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  18. 97 Medical Apparatuses tested at the Academic Medical Center (AMC) Amsterdam for interference by WLAN/WiFi signals

    NARCIS (Netherlands)

    Hensbroek, R.

    2009-01-01

    This research describes the influence of WLAN 1 signals on medical apparatuses in the Academic Medical Center (AMC) Amsterdam. The results in this report were obtained by testing medical equipment with WLAN signals. A comparable research was reported earlier. See TNO report KvL/P&Z 2007.117 dated

  19. 76 FR 21107 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2011-04-14

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... VA health care to enrolled Veterans residing in rural areas and discusses ways to improve and enhance... Secretary, VA Veteran Centers services, rural women Veteran health care, and the meeting agenda and planning...

  20. The effect of organizational climate on patient-centered medical home implementation.

    Science.gov (United States)

    Reddy, Ashok; Shea, Judy A; Canamucio, Anne; Werner, Rachel M

    2015-01-01

    Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points). © The Author(s) 2014.

  1. A midwifery-led in-hospital birth center within an academic medical center: successes and challenges.

    Science.gov (United States)

    Perdion, Karen; Lesser, Rebecca; Hirsch, Jennifer; Barger, Mary; Kelly, Thomas F; Moore, Thomas R; Lacoursiere, D Yvette

    2013-01-01

    The University of California San Diego Community Women's Health Program (CWHP) has emerged as a successful and sustainable coexistence model of women's healthcare. The cornerstone of this midwifery practice is California's only in-hospital birth center. Located within the medical center, this unique and physically separate birth center has been the site for more than 4000 births. With 10% cesarean delivery and 98% breast-feeding rates, it is an exceptional example of low-intervention care. Integrating this previously freestanding birth center into an academic center has brought trials of mistrust and ineffectual communication. Education, consistent leadership, and development of multidisciplinary guidelines aided in overcoming these challenges. This collaborative model provides a structure in which residents learn to be respectful consultants and appreciate differences in medical practice. The CWHP and its Birth Center illustrates that through persistence and flexibility a collaborative model of maternity services can flourish and not only positively influence new families but also future generations of providers.

  2. Dissemination of family-centered prevention for military and veteran families: adaptations and adoption within community and military systems of care.

    Science.gov (United States)

    Beardslee, William R; Klosinski, Lee E; Saltzman, William; Mogil, Catherine; Pangelinan, Susan; McKnight, Carl P; Lester, Patricia

    2013-12-01

    In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19-25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339-348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.

  3. Can the Theory of Planned Behavior Predict Dietary Intention and Future Dieting in an Ethnically Diverse Sample of Overweight and Obese Veterans Attending Medical Clinics?

    Science.gov (United States)

    Lash, Denise N.; Smith, Jane Ellen; Rinehart, Jenny K.

    2016-01-01

    Obesity has become a world-wide epidemic; in the United States (U.S.) approximately two-thirds of adults are classified as overweight or obese. Military veterans’ numbers are even higher, with 77% of retired or discharged U.S. veterans falling in these weight categories. One of the most common methods of changing one’s weight is through dieting, yet little is known regarding the factors that facilitate successful dieting behavior. The current investigation tested the Theory of Planned Behavior’s (TPB) ability to predict dietary intention and future dieting in a sample of 84 overweight and obese patients attending medical clinics at a Veterans Affairs Hospital in the southwestern part of the U.S. Participants primarily were male (92%) and ethnic/racial minorities (58%). Perceived need and anticipated regret were added to the standard TPB model. While the TPB predicted dietary intention, it did not significantly account for improved dietary behaviors. Anticipated regret significantly enhanced the basic TPB’s ability to predict intention to diet, while perceived need did not. These findings highlight the difficulty in predicting sustained change in a complex behavior such as dieting to lose weight. The need for more work with older, overweight/obese medical patients attending veterans’ facilities is stressed, as is the need for such work with male patients and ethnic minorities in particular. PMID:26792774

  4. Clinical Manifestations and mortality in neonatal septicemia; Children Medical Center

    Directory of Open Access Journals (Sweden)

    Milani SM

    2007-06-01

    Full Text Available Background: To identify the clinical manifestations and mortality rate among neonates with early- and late-onset sepsis. Methods: We retrospectively reviewed the hospital records in Children’s Hospital Medical Center, Tehran University of Medical Sciences of 104 neonates (50 females and 54 males diagnosed with septicemia and treated from September 1994 to August 1995. Diagnosis of septicemia was based on standard criteria. According to the time of onset of disease, there were 50 neonate with early-onset and 54 with late-onset septicemia. Results: Of the clinical signs in the 104 patients, respiratory signs were found in 31 patients, poor feeding in 57, jaundice in 42, apnea in 25 and hyporeflexia in 25. Blood cultures were positive in 31 (34.8% of the neonates: the most common species isolated was Staphylococcus aureus with eight cases, while five had Staphylococcus epidermidis, all of whom had a single species of bacterium isolated. Seventy-three (70% had normal birth weights (equal to or heavier than 2500 g and 31 (30% were classified as low birth weight (birth weight less than 2500 g. Cerebrospinal fluid culture was positive in four (6% of the patients, including one case of Escherichia coli, one Salmonella typhi, one Klebsiella, and one Staphylococcus aureus. The frequency of infection in male and female infants was 53% and 47%, respectively. Among the infants with early-onset sepsis, 16 (32% were low birth weight. Overall, the mortality rate among these patients was 30%, including 18 out of the 50 with early onset and 14 out of the 54 with late onset sepsis. Of these infants, 23 had meningitis, including 13 (26% with early-onset sepsis and 10 (9.6% with late-onset sepsis. Among the low birth weight infants, the mortality rate was higher (42% than that of the infants with normal birth weight (26%. Conclusion: Because of the high mortality rate among low birth weight neonates with sepsis, we suggest that this group of patients should

  5. Military veteran mortality following a survived suicide attempt

    Directory of Open Access Journals (Sweden)

    Conigliaro Joseph

    2011-05-01

    Full Text Available Abstract Background Suicide is a global public health problem. Recently in the U.S., much attention has been given to preventing suicide and other premature mortality in veterans returning from Iraq and Afghanistan. A strong predictor of suicide is a past suicide attempt, and suicide attempters have multiple physical and mental comorbidities that put them at risk for additional causes of death. We examined mortality among U.S. military veterans after hospitalization for attempted suicide. Methods A retrospective cohort study was conducted with all military veterans receiving inpatient treatment during 1993-1998 at United States Veterans Affairs (VA medical facilities following a suicide attempt. Deaths occurring during 1993-2002, the most recent available year at the time, were identified through VA Beneficiary and Records Locator System data and National Death Index data. Mortality data for the general U.S. adult population were also obtained from the National Center for Health Statistics. Comparisons within the veteran cohort, between genders, and against the U.S. population were conducted with descriptive statistics and standardized mortality ratios. The actuarial method was used estimate the proportion of veterans in the cohort we expect would have survived through 2002 had they experienced the same rate of death that occurred over the study period in the U.S. population having the age and sex characteristics. Results During 1993-1998, 10,163 veterans were treated and discharged at a VA medical center after a suicide attempt (mean age = 44 years; 91% male. There was a high prevalence of diagnosed alcohol disorder or abuse (31.8%, drug dependence or abuse (21.8%, psychoses (21.2%, depression (18.5%, and hypertension (14.2%. A total of 1,836 (18.1% veterans died during follow up (2,941.4/100,000 person years. The cumulative survival probability after 10 years was 78.0% (95% CI = 72.9, 83.1. Hence the 10-year cumulative mortality risk was 22

  6. Opportunity for Collaboration Between Radiation Injury Treatment Network Centers and Medical Toxicology Specialists.

    Science.gov (United States)

    Davlantes, Elizabeth; Shartar, Samuel; Venero, Jennifer; Steck, Alaina; Langston, Amelia; Kazzi, Ziad N

    2017-08-01

    The Radiation Injury Treatment Network (RITN) comprises >50 centers across the United States that are poised to care for victims of a radiation emergency. The network is organized around bone marrow transplant centers because these facilities excel in both radiation medicine and the care of patients with severe bone marrow depression. A radiation emergency may cause not only irradiation from an external source but also internal contamination with radioactive material. Because medical toxicologists are trained in radiation injury management and have expertise in the management of internal contamination, RITN centers may benefit from partnerships with medical toxicology resources, which may be located at academic medical centers, hospital inpatient clinical services, outpatient clinics, or poison control centers. We determined the locations of existing RITN centers and assessed their proximity to various medical toxicology resources, including medical toxicology fellowship programs, inpatient toxicology services, outpatient toxicology clinics, and poison control centers. Data were derived from publicly available Internet sources in March 2015. The majority of RITN centers do not have a medical toxicology fellowship, an inpatient toxicology service, or an outpatient toxicology clinic within the same institution. Fifty-seven percent of RITN centers have at least one of these resources located in the same city, however, and 73% of centers have at least one of these resources or a poison control center within the same city. Ninety-five percent of RITN centers have at least one medical toxicology resource within the state. Most RITN centers are located in the same city as at least one medical toxicology resource. Establishing relationships between RITN centers and medical toxicologists needs to be explored further.

  7. Factors influencing teamwork and collaboration within a tertiary medical center

    Science.gov (United States)

    Chien, Shu Feng; Wan, Thomas TH; Chen, Yu-Chih

    2012-01-01

    AIM: To understand how work climate and related factors influence teamwork and collaboration in a large medical center. METHODS: A survey of 3462 employees was conducted to generate responses to Sexton’s Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. RESULTS: Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R2 = 0.59) and in collaboration (R2 = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. CONCLUSION: Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are

  8. Voriconazole concentration monitoring at an academic medical center.

    Science.gov (United States)

    Sebaaly, Jamielynn C; MacVane, Shawn H; Hassig, Tanna B

    2016-03-01

    Results of a study of the relationship among voriconazole dosages, serum concentrations, adverse effects, and clinical outcomes are presented. A retrospective chart review was conducted that included all patients who had at least one voriconazole concentration drawn between July 1, 2009, and August 15, 2014, at a single academic medical center. The primary outcome was the proportion of patients with initial voriconazole concentrations in the target range. Forty-seven of 88 patients (53%) had an initial voriconazole concentration within the target range, 27% (24 of 88) of patients had a concentration above the range, and 19% (17 of 88) had a concentration below the range. Sixty-seven percent of patients with above-target concentrations had adverse effects. Voriconazole was discontinued in 9% of patients, and dosages were reduced in 11% of patients because of adverse effects. Voriconazole for treatment versus prophylaxis was analyzed in a subgroup, as was obesity and nonobesity. Twenty-four percent of patients died during their hospital admission, and 14% were not discharged on voriconazole therapy. The within-target group had the highest proportion of patients discharged on voriconazole and the lowest proportion of deaths. A retrospective study in one institution revealed that the first measured voriconazole concentration was within the target range in 53% of patients and that dosage was modified in only 51% of patients whose concentration was outside of that range. The majority of patients with above-target concentrations had an adverse effect, and this result was particularly common in patients with a body mass index of ≥35 kg/m(2). Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  9. Enriching Patient-Centered Medical Homes Through Peer Support.

    Science.gov (United States)

    Daaleman, Timothy P; Fisher, Edwin B

    2015-08-01

    Peer supporters are recognized by various designations-community health workers, promotores de salud, lay health advisers-and are community members who work for pay or as volunteers in association with health care systems or nonprofit community organizations and often share ethnicity, language, and socioeconomic status with the mentees that they serve. Although emerging evidence demonstrates the efficacy of peer support at the community level, the adoption and implementation of this resource into patient-centered medical homes (PCMHs) is still under development. To accelerate that integration, this article addresses three major elements of peer support interventions: the functions and features of peer support, a framework and programmatic strategies for implementation, and fiscal models that would support the sustained viability of peer support programs within PCMHs. Key functions of peer support include assistance in daily management of health-related behaviors, social and emotional support, linkage to clinical care, and longitudinal or ongoing support. An organizational model of innovation implementation provides a useful framework for determining how to implement and evaluate peer support programs in PCMHs. Programmatic strategies that can be useful in developing peer support programs within PCMHs include peer coaching or mentoring, group self-management training, and programs designed around the telephone and information technology. Fiscal models for peer support programs include linkages with hospital or health care systems, service- or community-based nonprofit organizations, and partnerships between health care systems and community groups. Peer support promises to enrich PCMHs by activating patients in their self-care, providing culturally sensitive outreach, and opening the way for partnerships with community-based organizations. © 2015 Annals of Family Medicine, Inc.

  10. Accountable care organization readiness and academic medical centers.

    Science.gov (United States)

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

  11. Medical Surveillance for a Soldier Centered Battlespace Awareness

    National Research Council Canada - National Science Library

    Schmorrow, Dylan D; Solhan, George; Kruse, Amy A

    2004-01-01

    .... Medical technologies have progressed to the degree that portable, rugged, and wireless designs can be conceived of that could give coalition commanders and medical personnel a view of the health...

  12. Women Veteran Report

    Data.gov (United States)

    Department of Veterans Affairs — This report summarizes the history of women Veterans in the military and as Veterans. It profiles the characteristics of women Veterans in 2015, and illustrates how...

  13. National imperative to establish a domestic medical intelligence center

    OpenAIRE

    Natarajan, Nitin

    2007-01-01

    CHDS State/Local The United States does not have a centralized organization tasked with the oversight or implementation of a domestic medical intelligence program. Organizations throughout the nation have adopted a variety of definitions and operating procedures related to medical intelligence; however, they are inconsistent. Additionally, most jurisdictions limit medical intelligence to epidemiological surveillance. This thesis will propose the structure, governmental organization, d...

  14. 77 FR 63424 - Announcement of Competition Under the America COMPETES Reauthorization Act of 2011: Veterans...

    Science.gov (United States)

    2012-10-16

    ... administer: 152 hospitals, sometimes known as VA Medical Centers or VAMCs, 971 outpatient clinics--most of... additional clinics in Guam and the Philippines. Veterans are administratively aligned with the hospital of... ability to technically integrate its products with Open Source VistA. Test environment: Analyses for the...

  15. College and Community Partnerships: Extending the Benefits of Therapeutic Recreation to Veterans

    Science.gov (United States)

    Fuchs, Steven J.; Cannella, Lee grace; Pisano, Susan

    2014-01-01

    In fall 2010, St. Joseph's College initiated a partnership between the college, Northport VA Medical Center, and Long Island State Veterans Home that provides a therapeutic platform for the integration of the three communities through sustainable and mutually beneficial curricular and co-curricular service and experiential learning programs. In…

  16. Impact of Mobile Dose-Tracking Technology on Medication Distribution at an Academic Medical Center.

    Science.gov (United States)

    Kelm, Matthew; Campbell, Udobi

    2016-05-01

    Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance (p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses (p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses (p = .01). The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed.

  17. Veterans and Homelessness

    Science.gov (United States)

    2013-11-29

    health care and rehabilitation services for homeless veterans (the Health Care for Homeless Veterans and Domiciliary Care for Homeless Veterans...Health Care for Homeless Veterans ................................................................................... 19 Domiciliary Care for Homeless...for Homeless Veterans (HCHV), Domiciliary Care for Homeless Veterans (DCHV), the Compensated Work Therapy/Therapeutic Residences Program, and the

  18. The Clinical Nurse Leader: impact on practice outcomes in the Veterans Health Administration.

    Science.gov (United States)

    Ott, Karen M; Haddock, K Sue; Fox, Sandra E; Shinn, Julie K; Walters, Sandra E; Hardin, James W; Durand, Kerri; Harris, James L

    2009-01-01

    The Clinical Nurse Leader (CNL) role was designed to meet an identified need for expert clinical leadership at the point of care. The Veterans Health Administration (VHA) became early adopters of the CNL role, foreseeing the value of this pivotal clinical leader at the point of care to meet the complex health care needs of America's veterans and shape health care delivery. Impact data were collected and assimilated from seven Veterans Administration Medical Centers to support how CNLs impact the delivery of quality and safe patient care and how practice changes could be sustained. Data collection and analyses resulted in many lessons learned. The new CNL role was implemented in a variety of settings in the VHA system. Integration of the CNL role in all areas of practice in every care setting has the promise of streamlining coordination of care for veterans across all spectrums in the provision of care.

  19. Adherence and systemic reaction rates to allergy immunotherapy among veterans.

    Science.gov (United States)

    Ellenburg, Joseph T; Lieberman, Jay A; Pattanaik, Debendra

    2016-01-01

    Although allergen immunotherapy (AIT) is effective and safe, nonadherence is common. Limited data exist regarding adherence to AIT, factors that affect adherence, and systemic reactions associated with AIT among veteran populations. To evaluate adherence to AIT and the prevalence of reactions secondary to AIT among patients at the Veterans Affairs Medical Center, Memphis, Tennessee. A retrospective chart review was performed of veterans who received AIT at a single Veterans Affairs facility. Age, race, sex, the total number of shots, travel distance, a diagnosis of posttraumatic stress disorder (PTSD), and the number of severe adverse reactions were compared between the veterans who were adherent and veterans who were nonadherent. The overall adherence rate was 60.9%. Factors associated with adherence were a chart diagnosis of PTSD (29.3% [adherent group] versus 13.6% [nonadherent group]; p = 0.03) and home residence being a further distance from the facility (21.9 miles / 35.2 kilometers [adherent group] versus 18.0 miles / 28.9 kilometers [nonadherent group]; p = 0.03). Patients who were adherent received an average of more total injections compared with patients who were nonadherent. Age, sex, race, and history of systemic reactions during AIT displayed no statistically significant differences between the groups. There were a total of 20 systemic reactions, and the systemic reaction rate was 0.2% per AIT encounter and 0.1% per injection. AIT adherence and systemic reaction rates among veterans at our facility was comparable with similar studies. Adherence was associated with a chart diagnosis of PTSD and home residence that was further away from the clinic.

  20. U.S. academic medical centers under the managed health care environment.

    Science.gov (United States)

    Guo, K

    1999-06-01

    This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U.S. health care system through their missions of conducting cutting-edge biomedical research, pursuing clinical and technological innovations, providing state-of-the-art medical care and producing highly qualified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical science. To survive the threats of managed care in the health care environment, academic medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 108 CEOs in all the academic medical centers in the U.S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

  1. Teaching in Medical Education | Center for Cancer Research

    Science.gov (United States)

    Many postdoctoral fellows are considering an academic career at a medical school. In addition to conducting research, new faculty members must learn effective teaching methodologies. This course will focus on good teaching practices, including basic strategies for developing and organizing a course. The purpose of the "Teaching in Medical Education (TIME)" course is to increase the scientist's ability to teach in medical education. The course will provide basic knowledge in teaching methods, course planning, writing a syllabus and developing examinations.

  2. Leadership Changes Announced At Equine Medical Center Fregin To Retire, White Interim Director

    OpenAIRE

    Douglas, Jeffrey S.

    2003-01-01

    Nathaniel White has been named Interim Director of the Marion duPont Scott Equine Medical Center in Leesburg. White, who assumed leadership responsibilities for the equine clinical and research center on April 1, succeeds G. Frederick Fregin, the center's founding director.

  3. The Medical Waste Management in Health Centers as the City of Pekanbaru

    Directory of Open Access Journals (Sweden)

    Emy Leonita

    2014-05-01

    Full Text Available The amount of medical waste comes from health facilities are expected more increasing. Based on Indonesia Health Profile 2008, amount of health centers reached 8,548 units. Management of medical waste from hospitals, health centers, clinics and medical laboratories in Indonesia is still under professional standards. In Pekanbaru city does not have accurate data on medical waste management in health centers, and therefore it necessary related research to see the extent of medical waste management health centers. This study aims to determine the medical waste management in health centers as the city of Pekanbaru. Type of research is descriptive qualitative, study was conducted in 20 health centers in Pekanbaru. The number of informants in this study were 21 people consisting of 20 holders of environmental health programs each health center and 1 holder of the environmental sanitation program at the City Health Office. Instrument research using in-depth interviews and observation sheets. Results reveal that a health center of Pekanbaru city has done a medical waste management ranging from segregation, collection, storage, transportation, yet at the stage of annihilation still less than the maximum. Constraints faced was funding the operation and maintenance personnel as well as there is no incinerator machine is not functioning properly

  4. Evaluation of the Veterans Health Administration's Specialty Care Transformational Initiatives to Promote Patient-Centered Delivery of Specialty Care: A Mixed-Methods Approach.

    Science.gov (United States)

    Williams, Katherine M; Kirsh, Susan; Aron, David; Au, David; Helfrich, Christian; Lambert-Kerzner, Anne; Lowery, Julie; Battaglia, Catherine; Graham, Glenn D; Doukas, Michael; Jain, Rajiv; Ho, P Michael

    2017-07-01

    Veteran's Affairs Office of Specialty Care (OSC) launched four national initiatives (Electronic-Consults [e-Consults], Specialty Care Access Networks-Extension for Community Healthcare Outcomes [SCAN-ECHO], Mini-Residencies, and Specialty Care Neighborhood) to improve specialty care delivery and funded a center to evaluate the initiatives. The evaluation, guided by two implementation frameworks, provides formative (administrator/provider interviews and surveys) and summative data (quantitative data on patterns of use) about the initiatives to OSC. Evaluation of initiative implementation is assessed through CFIR (Consolidated Framework for Implementation Research)-grounded qualitative interviews to identify barriers/facilitators. Depending on high or low implementation, factors such as receiving workload credit, protected time, existing workflow/systems compatibility, leadership engagement, and access to information/resources were considered implementation barriers or facilitators. Findings were shared with OSC and used to further refine implementation at additional sites. Evaluation of other initiatives is ongoing. The mixed-methods approach has provided timely information to OSC about initiative effect and impacted OSC policies on implementation at additional sites.

  5. 76 FR 59407 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

    Science.gov (United States)

    2011-09-26

    ... Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the Diagnosis... scientific and medical literature and information concerning the use of non-standardized allergenic extracts... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information...

  6. A national evaluation of homeless and nonhomeless veterans' experiences with primary care.

    Science.gov (United States)

    Jones, Audrey L; Hausmann, Leslie R M; Haas, Gretchen L; Mor, Maria K; Cashy, John P; Schaefer, James H; Gordon, Adam J

    2017-05-01

    Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not access or receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons' avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and nonhomeless veterans with MHSUDs receiving care in the Veterans Health Administration's medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Health Care Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth "homeless") were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 veterans with MHSUDs (9.2% homeless). Compared with their nonhomeless counterparts, homeless veterans were younger, more likely to be non-Hispanic Black and nonmarried, had less education, and were more likely to live in urban areas. Homeless veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than nonhomeless veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  7. Drug allergy and medical records in Health center 'Zvezdara'

    Directory of Open Access Journals (Sweden)

    Vićentijević-Radosavljević Svetlana S.

    2017-01-01

    Full Text Available Objective: This paper analyses the compliance of medical records of drug allergies and incidence of the allergies. Identifying the drug as an allergy-causing agent is important in order to prevent re-exposure which could be harmful or even life-threatening. Method: In the period December 2011-February 2012, the survey of drug allergy was conducted on 300 patients aged 21 to 87 years. During this period, the author personally interviewed the patients and recorded their answers. Results: Analysis determined allergies in 52 cases (17.3% and in all cases, data on allergies were added to the official medical documentation. However, comparing with the personal medical card (PMC we found that there is a conflict between the PMC and the official medical documentation in about 40% of cases. The greatest presence of allergy was on penicillin, cephalosporins and non-steroidal anti-inflammatory drugs. The most common symptoms of allergic reactions are shock, choking, the appearance of redness and skin rash. Conclusion: The conclusion of the analysis is that medical records of patients' allergies are not fully aligned and there is a significant mismatch between the actual condition and the recorded data. Better records of allergies in the medical documentation are needed in order to prevent the risk of incorrect treatment.

  8. Voluntary and involuntary childlessness in female veterans: associations with sexual assault.

    Science.gov (United States)

    Ryan, Ginny L; Mengeling, Michelle A; Booth, Brenda M; Torner, James C; Syrop, Craig H; Sadler, Anne G

    2014-08-01

    To assess associations between lifetime sexual assault and childlessness in female veterans. Cross-sectional, computer-assisted telephone interview study. Two Midwestern Veterans Administration (VA) medical centers. A total of 1,004 women aged ≤52 years, VA-enrolled between 2000 and 2008. None. Sociodemographic variables, reproductive history and care utilization, and mental health. A total of 620 veterans (62%) reported at least one attempted or completed sexual assault in their lifetime (LSA). Veterans with LSA more often self-reported a history of pregnancy termination (31% vs. 19%) and infertility (23% vs. 12%), as well as sexually transmitted infection (42% vs. 27%), posttraumatic stress disorder (32% vs. 10%), and postpartum dysphoria (62% vs. 44%). Lifetime sexual assault was independently associated with termination and infertility in multivariate models; sexually transmitted infection, posttraumatic stress disorder, and postpartum dysphoria were not. The LSA by period of life was as follows: 41% of participants in childhood, 15% in adulthood before the military, 33% in military, and 13% after the military (not mutually exclusive). Among the 511 who experienced a completed LSA, 23% self-reported delaying or foregoing pregnancy because of their assault. This study demonstrated associations between sexual assault history and pregnancy termination, delay or avoidance (voluntary childlessness), and infertility (involuntary childlessness) among female veterans. Improved gender-specific veteran medical care must attend to these reproductive complexities. Copyright © 2014 American Society for Reproductive Medicine. All rights reserved.

  9. Crozer-Chester Medical Center Burn Research Project

    Science.gov (United States)

    2013-09-01

    Center Task Force evalu~ ating A. bntmlflnnii infections in our burn center. 403 404 Ackemum ct nl An initial analysis of 150 patients indicated that...enalapril had demonstrated worsening of renal function, proteinuria , and hyperkalemia. Thus, a change from enalapril to 5 mg of amlodipine was suggested...568.9 92.4-95.4 91.2-94.7 89.9-93.9 74.7-84.8 32 Peak Trough Pairs creatinine clearance 101 - 150 mL/min Median 267.6 93.7 92.7 91.6 79.1 IQ 25 -75

  10. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic Training - ... Readjustment Counseling (Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning Service Members Rural Veterans ...

  11. [Analysis of the transfer of the world medical scientific center until modern times].

    Science.gov (United States)

    Zuo, Han-bin

    2010-03-01

    Since the 16th century, the world medical scientific center has transferred from Italy, Netherlands, the United Kingdom, France and Germany to the United States. The standards by which the above-mentioned countries became the medical scientific center during a certain historical period were not only the number of achievements of the scientific research and the talents, what was more important was their position and function in the leading disciplines. The background of the transfer of the medical scientific center was the economic, cultural and political rise of these countries, and the most important foundation was the innovation of personnel training systems.

  12. Substance use disorders in military veterans: prevalence and treatment challenges

    Directory of Open Access Journals (Sweden)

    Teeters JB

    2017-08-01

    Full Text Available Jenni B Teeters,1,2 Cynthia L Lancaster,1,2 Delisa G Brown,3 Sudie E Back1,2 1Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; 2Ralph H Johnson Veterans Affairs (VA Medical Center, Charleston, SC, USA, 3Department of Human Development and Psychoeducation, Howard University, Washington, DC, USA Abstract: Substance use disorders (SUDs are a significant problem among our nation’s military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed. Keywords: addiction, alcohol use disorders, drug use disorders, treatment, pharmacotherapy, psychotherapy

  13. An academic medical center model for community colorectal cancer screening: the Centers for Disease Control and Prevention demonstration program experience.

    Science.gov (United States)

    Lane, Dorothy S; Cavanagh, Mary F; Messina, Catherine R; Anderson, Joseph C

    2010-08-01

    During 2005-2009, the Centers for Disease Control and Prevention funded five colorectal cancer (CRC) screening demonstration projects around the United States; only one was based in an academic medical center (AMC) rather than a health department. The Suffolk County Preventive Endoscopy Project (Project SCOPE) was a collaborative effort between Stony Brook University Medical Center (SBUMC) and the Suffolk County Department of Health Services. Project SCOPE's objective was to increase CRC screening among Suffolk County residents at least 50 years old who had inadequate or no insurance coverage for CRC screening. The demonstration application drew on the screening, diagnostic, and treatment resources of the AMC and the indigent populations using its outpatient clinics. Patients at 10 county health centers were a primary target for (previously inaccessible) colonoscopy screening. The project's organizational center was SBUMC's preventive medicine department, which was linked to SBUMC's large gastroenterology practice. The specific staffing, financial, and training issues faced by this project provide insights for others who are similarly interested in community engagement. During 40 months of screening, 800 indigent, culturally diverse patients were recruited, and they underwent colonoscopy. Challenges encountered included unreachable referred patients (425 patients; 28% of referrals) and medical ineligibility (e.g., symptomatic comorbid conditions). Pending legislation providing federal funding for a national program offers other AMCs the opportunity to adopt a model such as that proven feasible during Project SCOPE. The lessons learned may have broader application for fostering collaborative AMC partnerships and for enhancing recruitment and retention of participants through outreach.

  14. Development of a Patient-Centered Antipsychotic Medication Adherence Intervention

    Science.gov (United States)

    Pyne, Jeffrey M.; Fischer, Ellen P.; Gilmore, LaNissa; McSweeney, Jean C.; Stewart, Katharine E.; Mittal, Dinesh; Bost, James E.; Valenstein, Marcia

    2014-01-01

    Objective: A substantial gap exists between patients and their mental health providers about patient's perceived barriers, facilitators, and motivators (BFMs) for taking antipsychotic medications. This article describes how we used an intervention mapping (IM) framework coupled with qualitative and quantitative item-selection methods to…

  15. Smartphones in medicine: emerging practices in an academic medical center.

    Science.gov (United States)

    Johnson, Angela C; El Hajj, Stephanie C; Perret, J Nelson; Caffery, Terrell S; Jones, Glenn N; Musso, Mandi W

    2015-01-01

    Advances in mobile phone technology now provide a myriad of resources to physicians' fingertips. However, the medical profession continues to struggle with potential for misuse of these devices. There is a need for better understanding of physicians' uses of smartphones in order to establish guidelines for appropriate and professional behavior. The purpose of the current study was to survey physicians' and medical students' practices concerning smartphone use in the healthcare setting. Physicians and medical students were asked to complete anonymous surveys regarding uses of smartphones within the past month in various healthcare settings. Overall, the participants reported distinctly different patterns in the uses they made of their phones in different settings (P<.001), with most individuals engaging in most behaviors while on break but few using their smartphones while with patients or during procedures. It appears that physicians and medical students make decisions about using their smartphones according to some combination of three considerations: degree of relevance to patient care, the appropriateness of the behavior in front of patients, and the issue of how disruptive that behavior may be.

  16. Emergency department discharge prescription errors in an academic medical center.

    Science.gov (United States)

    Murray, Kelly A; Belanger, April; Devine, Lauren T; Lane, Aaron; Condren, Michelle E

    2017-04-01

    This study described discharge prescription medication errors written for emergency department patients. This study used content analysis in a cross-sectional design to systematically categorize prescription errors found in a report of 1000 discharge prescriptions submitted in the electronic medical record in February 2015. Two pharmacy team members reviewed the discharge prescription list for errors. Open-ended data were coded by an additional rater for agreement on coding categories. Coding was based upon majority rule. Descriptive statistics were used to address the study objective. Categories evaluated were patient age, provider type, drug class, and type and time of error. The discharge prescription error rate out of 1000 prescriptions was 13.4%, with "incomplete or inadequate prescription" being the most commonly detected error (58.2%). The adult and pediatric error rates were 11.7% and 22.7%, respectively. The antibiotics reviewed had the highest number of errors. The highest within-class error rates were with antianginal medications, antiparasitic medications, antacids, appetite stimulants, and probiotics. Emergency medicine residents wrote the highest percentage of prescriptions (46.7%) and had an error rate of 9.2%. Residents of other specialties wrote 340 prescriptions and had an error rate of 20.9%. Errors occurred most often between 10:00 am and 6:00 pm.

  17. The National Center for Collaboration in Medical Modeling and Simulation

    Science.gov (United States)

    2006-11-01

    Tireless Work Ethic, Preparedness, Intellectual Giftedness and Curiosity, Humility, Compassion, Devotion to Field, Rapid Decision Making, and Passion for...Intellectual Giftedness 23 Displaying an ability to process an and Curiosity enormous amount of medical information and grasp new concepts very quickly... Giftedness and Curiosity Ten participants indicated that a combination of intellectual giftedness and intellectual curiosity distinguishes expert from average

  18. Optimizing strategies to improve interprofessional practice for veterans, part 1

    Directory of Open Access Journals (Sweden)

    Bhattacharya SB

    2014-04-01

    Full Text Available Shelley B Bhattacharya,1–3 Michelle I Rossi,1,2 Jennifer M Mentz11Geriatric Research Education and Clinical Center (GRECC, Veteran's Affairs Pittsburgh Healthcare System, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 3Albert Schweitzer Fellowship Program, Pittsburgh, PA, USAIntroduction: Interprofessional patient care is a well-recognized path that health care systems are striving toward. The Veteran's Affairs (VA system initiated interprofessional practice (IPP models with their Geriatric Evaluation and Management (GEM programs. GEM programs incorporate a range of specialties, including but not limited to, medicine, nursing, social work, physical therapy and pharmacy, to collaboratively evaluate veterans. Despite being a valuable resource, they are now faced with significant cut-backs, including closures. The primary goal of this project was to assess how the GEM model could be optimized at the Pittsburgh, Pennsylvania VA to allow for the sustainability of this important IPP assessment. Part 1 of the study evaluated the IPP process using program, patient, and family surveys. Part 2 examined how well the geriatrician matched patients to specialists in the GEM model. This paper describes Part 1 of our study.Methods: Three strategies were used: 1 a national GEM program survey; 2 a veteran/family satisfaction survey; and 3 an absentee assessment.Results: Twenty-six of 92 programs responded to the GEM IPP survey. Six strategies were shared to optimize IPP models throughout the country. Of the 34 satisfaction surveys, 80% stated the GEM clinic was beneficial, 79% stated their concerns were addressed, and 100% would recommend GEM to their friends. Of the 24 absentee assessments, the top three reasons for missing the appointments were transportation, medical illnesses, and not knowing/remembering about the appointment. Absentee rate diminished from 41% to 19% after instituting a reminder phone call policy.Discussion: Maintaining the

  19. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There ... see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from ...

  20. Equipment for nuclear medical centers, production capabilities of Rosatom enterprises

    Energy Technology Data Exchange (ETDEWEB)

    Gavrish, Yu. N., E-mail: gavrish@luts.niiefa.spb.su [JSC Efremov Institute of Electrophysical Apparatus (Russian Federation); Koloskov, S. A. [JSC Scientific Research Institute of Technical Physics and Automation (Russian Federation); Smirnov, V. P. [JSC Science and Innovation (Russian Federation); Strokach, A. P. [JSC Efremov Institute of Electrophysical Apparatus (Russian Federation)

    2015-12-15

    Analysis of the capabilities of the State Corporation Rosatom enterprises on the development and production of diagnostic and therapeutic equipment for nuclear medicine centers is presented. Prospects of the development of accelerator equipment for the production of a wide range of radioisotope products are shown, and the trends of its development are determined. A comparative analysis of the technical parameters of domestic tomographs and devices for brachytherapy with foreign counterparts is given.

  1. Medical center uses web site, print to promote community education. Complementary ad efforts build attendance for classes. MidMichigan Medical Center-Midland.

    Science.gov (United States)

    Herreria, J

    1998-01-01

    MidMichigan Medical Center employs the use of Internet technology and print advertisements to complement each other. Together with advertising agency Bolger + Battle in Midland, the hospital devised a plan to generate awareness and registration for upcoming community education classes.

  2. Cost-Benefit Analysis of Radiation Therapy Services at Tripler Army Medical Center

    National Research Council Canada - National Science Library

    Diehl, Diane S

    2004-01-01

    The purpose of this analysis was to examine the costs and benefits associated with continuance of "in-house" radiation therapy services to eligible beneficiaries at Tripler Army Medical Center (TAMC...

  3. An Analysis of the Nurse Internship Program at Naval Medical Center San Diego

    National Research Council Canada - National Science Library

    Gillard, Elizabeth

    2003-01-01

    ...) at Naval Medical Center San Diego. The NIP provides nurses with no or little nursing experience an opportunity to participate in professional development as United States Navy Nurse Corps officers...

  4. Analysis of Long-stay Patients in the Hospice Palliative Ward of a Medical Center

    Directory of Open Access Journals (Sweden)

    Ming-Hwai Lin

    2008-06-01

    Conclusion: Better understanding of the factors related to LOS can help staff in the palliative ward of medical centers to identify patients who are apt to have long stay, and shorten their LOS by successfully dealing with their problems.

  5. Master's Level Graduate Training in Medical Physics at the University of Colorado Health Sciences Center.

    Science.gov (United States)

    Ibbott, Geoffrey S.; Hendee, William R.

    1980-01-01

    Describes the master's degree program in medical physics developed at the University of Colorado Health Sciences Center. Required courses for the program, and requirements for admission are included in the appendices. (HM)

  6. Trust is the basis for effective suicide risk screening and assessment in veterans.

    Science.gov (United States)

    Ganzini, Linda; Denneson, Lauren M; Press, Nancy; Bair, Matthew J; Helmer, Drew A; Poat, Jennifer; Dobscha, Steven K

    2013-09-01

    To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process. To explore Veterans' perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts. Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach. Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010. Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts. In ambulatory care settings, both provider

  7. Clinical characteristics of adult tetanus in a Taiwan medical center

    Directory of Open Access Journals (Sweden)

    Wei-Chieh Weng

    2011-11-01

    Conclusion: This study revealed several characteristics of adult tetanus cases in the post-vaccine era in Taiwan. Further serological studies and improved tetanus vaccinations may be needed to ensure better protection, especially for high-risk populations. The exceptionally good prognosis for our patients confirms that appropriate treatment, including wound care, early diagnosis, proper medication, and prevention of complications, is essential in managing this traditional curable disease.

  8. National Imperative to Establish a Domestic Medical Intelligence Center

    Science.gov (United States)

    2007-09-01

    American Medical Association 276 (1996): 419–420. 6. Joan Stephenson, “ Confronting a Biological Armageddon: Experts Tackle Prospect of Bioterrorism...unit o Pediatric unit o Surgical unit o Trauma unit o Nephrology unit ( dialysis ) • Laboratory o Chemistry o Hematology o Histology o...Principles of Public Health Practice. Clifton Park: Thomas Delmar Learning, 2002. Stephenson, Joan. “ Confronting a Biological Armageddon: Experts

  9. The Ismail Center Hypertension Program: Application of Medical Nutrition Therapy

    OpenAIRE

    Darbishire, Lily

    2016-01-01

    Lily Darbishire is a registered dietitian nutritionist and graduate student at Missouri State University completing a master’s degree in public health. During her senior year in the dietetics program at Purdue University, Darbishire was involved in a service-learning–based hypertension clinic focusing on medical nutrition therapy. This article outlines her experiences and what she learned as a result of completing the program.

  10. The history of neurological surgery at rush university medical center.

    Science.gov (United States)

    Boco, Tibor; Jobe, Kirk W; O'Leary, Shaun T; Byrne, Richard W; Whisler, Walter W

    2010-10-01

    The history of neurosurgery at Rush University is tightly linked to the emergence of neurological surgery in the city of Chicago. Rush Medical College (RMC) was chartered in 1837 and in 1898 began an affiliation with the newly founded University of Chicago (UC), which proceeded to full union in 1923 as the Rush Medical College of the University of Chicago (RMC/UC). Percival Bailey founded neurosurgery at the RMC/UC and started a neurosurgery training program at the South Side campus in 1928. In 1935, Adrien Ver Brugghen started the first neurosurgical training program at the West Side campus at the Presbyterian Hospital/RMC. The major alliances with RMC have involved the Cook County Hospital, the Presbyterian Hospital, the UC, the University of Illinois, and St. Luke's Hospital. Those affiliations significantly shaped Rush neurosurgery. The RMC/UC union was dissolved in 1941, and an affiliation was formed with the University of Illinois in Chicago (UI). In 1959, Eric Oldberg, the founder and Chairman of Neurosurgery at the UI, became the next chairman of neurosurgery at Presbyterian-St. Luke's Hospital, incorporating it into the UI program. He was succeeded in 1970 by Walter Whisler, who founded the first independent and board-approved neurosurgery residency program in 1972 at the newly reactivated Rush Medical College. Whisler was chairman until 1999, when Leonard Cerullo, founder of the Chicago Institute of Neurosurgery and Neuroresearch, became chairman at Rush. Richard Byrne, appointed in 2007, is the current chairman of the Rush University neurosurgery department.

  11. Teaching professional writing in an academic health sciences center: the Writing Center model at the Medical University of South Carolina.

    Science.gov (United States)

    Smith, Tom G; Ariail, Jennie; Richards-Slaughter, Shannon; Kerr, Lisa

    2011-01-01

    Writing is taught as professional competency in higher education generally, but the health science education literature emphasizes writing as a pedagogical means rather than a professional end. The Medical University of South Carolina established a Writing Center in 1994 to teach professional writing. This report describes the rationale for profession-specific, graduate-level writing instruction; summarizes the Writing Center model; and reports usage data. Students have reported improvement in particular texts and said they would be better able to complete writing tasks in the future. Interventions modeled after the Writing Center and staffed with professionally trained writing teachers may provide a means to pool resources to teach writing as professional competency. The Writing Center has provided the expertise to teach professional writing without demanding curricular revision.

  12. Multimethod evaluation of the VA's peer-to-peer Toolkit for patient-centered medical home implementation.

    Science.gov (United States)

    Luck, Jeff; Bowman, Candice; York, Laura; Midboe, Amanda; Taylor, Thomas; Gale, Randall; Asch, Steven

    2014-07-01

    Effective implementation of the patient-centered medical home (PCMH) in primary care practices requires training and other resources, such as online toolkits, to share strategies and materials. The Veterans Health Administration (VA) developed an online Toolkit of user-sourced tools to support teams implementing its Patient Aligned Care Team (PACT) medical home model. To present findings from an evaluation of the PACT Toolkit, including use, variation across facilities, effect of social marketing, and factors influencing use. The Toolkit is an online repository of ready-to-use tools created by VA clinic staff that physicians, nurses, and other team members may share, download, and adopt in order to more effectively implement PCMH principles and improve local performance on VA metrics. Multimethod evaluation using: (1) website usage analytics, (2) an online survey of the PACT community of practice's use of the Toolkit, and (3) key informant interviews. Survey respondents were PACT team members and coaches (n = 544) at 136 VA facilities. Interview respondents were Toolkit users and non-users (n = 32). For survey data, multivariable logistic models were used to predict Toolkit awareness and use. Interviews and open-text survey comments were coded using a "common themes" framework. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analyses. The Toolkit was used by 6,745 staff in the first 19 months of availability. Among members of the target audience, 80 % had heard of the Toolkit, and of those, 70 % had visited the website. Tools had been implemented at 65 % of facilities. Qualitative findings revealed a range of user perspectives from enthusiastic support to lack of sufficient time to browse the Toolkit. An online Toolkit to support PCMH implementation was used at VA facilities nationwide. Other complex health care organizations may benefit from adopting similar online peer-to-peer resource libraries.

  13. Veterans Crisis Line

    Data.gov (United States)

    Department of Veterans Affairs — The caring responders at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances. Some of the responders are...

  14. Trend of knowledge production of research centers in the field of medical sciences in iran.

    Science.gov (United States)

    Falahat, K; Eftekhari, Mb; Habibi, E; Djalalinia, Sh; Peykari, N; Owlia, P; Malekafzali, H; Ghanei, M; Mojarrab, Sh

    2013-01-01

    Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI (web of science). Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country.

  15. DOE Center of Excellence in Medical Laser Applications. Final report, December 1, 1994--November 30, 1997

    Energy Technology Data Exchange (ETDEWEB)

    Jacques, S.L.

    1998-01-01

    An engineering network of collaborating medical laser laboratories are developing laser and optical technologies for medical diagnosis and therapy and are translating the engineering into medical centers in Portland OR, Houston TX, and Galveston TX. The Center includes the University of Texas M.D. Anderson Cancer Center, the University of Texas-Austin, Texas A and M University, Rice University, the University Texas Medical Branch-Galveston, Oregon Medical Laser Center (Providence St. Vincent Medical Center, Oregon Health Sciences University, and Oregon Graduate Institute, Portland, OR), and the University of Oregon. Diagnostics include reflectance, fluorescence, Raman IR, laser photoacoustics, optical coherence tomography, and several new video techniques for spectroscopy and imaging. Therapies include photocoagulation therapy, laser welding, pulsed laser ablation, and light-activated chemotherapy of cancer (photodynamic therapy, or PDT). Medical applications reaching the clinic include optical monitoring of hyperbilirubinemia in newborns, fluorescence detection of cervical dysplasia, laser thrombolysis of blood clots in heart attack and brain stroke, photothermal coagulant of benign prostate hyperplasia, and PDT for both veterinary and human cancer. New technologies include laser optoacoustic imaging of breast tumors and hemorrhage in head trauma and brain stroke, quality control monitoring of dosimetry during PDT for esophageal and lung cancer, polarization video reflectometry of skin cancer, laser welding of artificial tissue replacements, and feedback control of laser welding.

  16. How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?

    Science.gov (United States)

    Myaskovsky, Larissa; Gao, Shasha; Hausmann, Leslie R M; Bornemann, Kellee R; Burkitt, Kelly H; Switzer, Galen E; Fine, Michael J; Phillips, Samuel L; Gater, David; Spungen, Ann M; Boninger, Michael L

    2017-09-01

    To understand the role of cultural and psychosocial factors in the outcomes of veteran wheelchair users with spinal cord injury (SCI) to help clinicians identify unique factors faced by their patients and help researchers identify target variables for interventions to reduce disparities in outcomes. Cross-sectional cohort study. Three urban Veterans Affairs medical centers affiliated with academic medical centers. Of the patients (N=516) who were eligible to participate, 482 completed the interview and 439 had SCI. Because of small numbers in other race groups, analyses were restricted to white and African American participants, resulting in a final sample of 422. Not applicable. Quality of life (QOL, Veterans RAND 12-Item Health Survey); satisfaction (Client Satisfaction Questionnaire); and participation (Craig Handicap Assessment and Reporting Technique Short Form). African American Veterans reported poorer physical QOL but better mental QOL than did white Veterans. No other significant race differences were found in unadjusted analyses. Multivariable analyses showed that psychosocial factors were predominantly associated with patients' QOL outcomes and satisfaction with service, but demographic and medical factors were predominantly associated with participation outcomes. Interaction analyses showed that there was a stronger negative association between anxiety and mental QOL for African Americans than for whites, and a positive association between higher self-esteem and social integration for whites but not African Americans. Findings suggest that attempts to improve the outcomes of Veterans with SCI should focus on a tailored approach that emphasizes patients' demographic, medical, and psychosocial assets (eg, building their sense of self-esteem or increasing their feelings of mastery), while providing services targeted to their specific limitations (eg, reducing depression and anxiety). Published by Elsevier Inc.

  17. Protocol for the evaluation of a digital storytelling approach to address stigma and improve readiness to seek services among veterans.

    Science.gov (United States)

    Bunnell, Brian E; Davidson, Tatiana M; Hamblen, Jessica L; Cook, Danna L; Grubaugh, Anouk L; Lozano, Brian E; Tuerk, Peter W; Ruggiero, Kenneth J

    2017-01-01

    Research suggests that at least 10% of veterans returning from Iraq and Afghanistan meet criteria for posttraumatic stress disorder (PTSD) related to their military experiences. National dissemination initiatives have increased veterans' access to best-practice interventions. However, treatment-seeking remains low among veterans with PTSD, often due to perceived stigma and other associated barriers. The National Center for PTSD recently developed and launched AboutFace, a digital storytelling (DST) resource designed to help veterans recognize PTSD and motivate them to seek evidence-based treatment. The Ralph H. Johnson Veterans Affairs Medical Center (VAMC) and the National Center for PTSD have partnered to conduct pilot work to evaluate veterans' reactions to AboutFace to set the stage for a large-scale study to examine whether AboutFace effectively reduces stigma and improves attitudes toward treatment-seeking among veterans. If effective, this DST approach may serve as a valuable national model for a variety of treatment-seeking populations. During the first phase of the pilot, in-person usability assessments of AboutFace will be conducted via semi-structured interviews with 20 veterans. Audio recordings of interviews will undergo transcription and coding. A report of the results of qualitative analyses of these interviews will be provided to the National Center for PTSD and will inform revisions to the site. In the second phase of the pilot, 60 veterans referred to a specialized PTSD clinic will be recruited to demonstrate and refine the methodology that we propose to use in a larger randomized controlled trial evaluation of AboutFace. Veterans will be randomly assigned to receive AboutFace plus standard education vs. standard education alone. Baseline and 2-week telephone assessments will be conducted with participating veterans to measure stigma, attitudes toward seeking mental health services, and treatment access/engagement. The feedback we receive in this

  18. Medication Adherence among Adolescents in a School-Based Health Center

    Science.gov (United States)

    Mears, Cynthia J.; Charlebois, Nicole M.; Holl, Jane L.

    2006-01-01

    School-based health centers are an integral part of the health care delivery system for low-income children. Medication adherence for these patients may be challenging because the student is often responsible for bringing home the prescription and receiving the instructions. This study assesses medication fill, initiation, and adherence rates…

  19. The Institute for Safe Medication Practices and Poison Control Centers: Collaborating to Prevent Medication Errors and Unintentional Poisonings.

    Science.gov (United States)

    Vaida, Allen J

    2015-06-01

    This article provides an overview on the Institute for Safe Medication Practices (ISMP), the only independent nonprofit organization in the USA devoted to the prevention of medication errors. ISMP developed the national Medication Errors Reporting Program (MERP) and investigates and analyzes errors in order to formulate recommendations to prevent further occurrences. ISMP works closely with the US Food and Drug Administration (FDA), drug manufacturers, professional organizations, and others to promote changes in package design, practice standards, and healthcare practitioner and consumer education. By collaborating with ISMP to share and disseminate information, Poison Control centers, emergency departments, and toxicologists can help decrease unintentional and accidental poisonings.

  20. Determining the Optimal Inventory Management Policy for Naval Medical Center San Diego’s Pharmacy

    Science.gov (United States)

    2016-12-01

    resources. This thesis will examine the inventory management of one of the largest pharmacies in Navy Medicine , Naval Medical Center San Diego...there. This leaves a lot of room for error ; there could be misplaced medications or several bottles off the shelf because they are being used, and...include the totals for the specified time (one day) and all of the medications dispensed for that day (Science Applications International Corporations

  1. Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

    Science.gov (United States)

    Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

    2017-01-01

    Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

  2. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans.

    Science.gov (United States)

    Marcum, Zachary A; Amuan, Megan E; Hanlon, Joseph T; Aspinall, Sherrie L; Handler, Steven M; Ruby, Christine M; Pugh, Mary Jo V

    2012-01-01

    To describe the prevalence of unplanned hospitalizations caused by adverse drug reactions (ADRs) in older veterans and to examine the association between this outcome and polypharmacy after controlling for comorbidities and other patient characteristics. Retrospective cohort. Veterans Affairs Medical Centers. Six hundred seventy-eight randomly selected unplanned hospitalizations of older (aged ≥ 65) veterans between October 1, 2003, and September 30, 2006. Naranjo ADR algorithm, ADR preventability, and polypharmacy (0-4, 5-8, and ≥9 scheduled medications). Seventy ADRs involving 113 drugs were found in 68 (10%) hospitalizations of older veterans, of which 25 (36.8%) were preventable. Extrapolating to the population of more than 2.4 million older veterans receiving care during the study period, 8,000 hospitalizations may have been unnecessary. The most common ADRs that occurred were bradycardia (n = 6; beta-blockers, digoxin), hypoglycemia (n = 6; sulfonylureas, insulin), falls (n = 6; antidepressants, angiotensin-converting enzyme inhibitors), and mental status changes (n = 6; anticonvulsants, benzodiazepines). Overall, 44.8% of veterans took nine or more outpatient medications and 35.4% took five to eight. Using multivariable logistic regression and controlling for demographic, health-status, and access-to-care variables, polypharmacy (≥9 and 5-8) was associated with greater risk of ADR-related hospitalization (adjusted odds ratio (AOR) = 3.90, 95% confidence interval (CI) = 1.43-10.61 and AOR = 2.85, 95% CI = 1.03-7.85, respectively). ADRs, determined using a validated causality algorithm, are a common cause of unplanned hospitalization in older veterans, are frequently preventable, and are associated with polypharmacy. © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

  3. Joint replacement surgery in homeless veterans

    Directory of Open Access Journals (Sweden)

    Chase G. Bennett, MD

    2017-12-01

    Full Text Available Total joint arthroplasty (TJA in a homeless patient is generally considered contraindicated. Here, we report our known medical and social (housing and employment results of homeless veterans who had TJA. Thirty-seven TJAs were performed on 33 homeless patients (31 men at our hospital between November 2000 and March 2014. This was 1.2% of all TJAs. Average age was 54 years. Average hospital stay was 4.1 days. There were no major inpatient complications. Thirty-four cases had at least 1-year follow-up in any clinic within the Veterans Affairs health care system. There were no known surgery-related reoperations or readmissions. At final follow-up, 24 patients had stable housing and 9 were employed. The extensive and coordinated medical and social services that were provided to veterans from the Department of Veterans Affairs contributed to our positive results. Keywords: Homeless, Veteran, Joint replacement, Total hip, Total knee, Employment

  4. Interns' experiences of disruptive behavior in an academic medical center.

    Science.gov (United States)

    Mullan, Charles P; Shapiro, Jo; McMahon, Graham T

    2013-03-01

    The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice. To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment. All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated. A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P  =  .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P disruption. Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.

  5. Factors Concerning Veterans With Dementia, Their Caregivers, and Coordination of Care: A Systematic Literature Review.

    Science.gov (United States)

    Mileski, Michael; Scott Kruse, Clemens; Brooks, Matthew; Haynes, Christine; Collingwood, Ying; Rodriguez, Rachel

    2017-11-01

    Military veterans diagnosed with dementia compose a large portion of our population. Often ignored are their caregivers and their plight as well as the availability, quality, and accessibility of health care for this demographic. The purpose of this systematic literature review is three fold: to identify opportunities available to increase public awareness on the subject; to identify areas of improvement in the level of care and quality of life for our nation's veterans; and to identify if adequate resources are available to veterans with dementia and their caregivers. The authors conducted systematic searches of three databases: PubMed via The National Center for Biotechnology Information, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), and Google. Data were collected regarding providing care to veterans who are suffering from dementia or Alzheimer's disease and their caregivers between 2008 and June 2016. Search results were filtered by date range, full text, English language, Boolean operators, and academic journals (n = 14). The review confirmed there are many facilitators and barriers in the coordination of care offered to veterans with dementia. Facilitators of quality care include veteran's expectations, family support, program development, and the availability of services. These positive aspects are aided by several community-based support services, new technology, and preventative care. Barriers are caregiver expectations, coordination of care, providers, and informal and formal costs. These negative facets are due to lack of educational resources, an increased veteran population diagnosed with dementia, limited knowledge of resources, and limited medical service in rural areas. Overall, there are a number of community programs that want to, and can, help veterans with dementia. There are also a number of ways to help veterans with dementia cope with their issues, which include

  6. Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure.

    Science.gov (United States)

    Yam, Felix K; Lew, Tiffany; Eraly, Satish A; Lin, Hsiang-Wen; Hirsch, Jan D; Devor, Michelle

    2016-01-01

    Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit. To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC. This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits. A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911-1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001). Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do

  7. Cancers in Eastern Libya: first results from Benghazi Medical Center.

    Science.gov (United States)

    Bodalal, Zuhir; Azzuz, Raouf; Bendardaf, Riyad

    2014-05-28

    To study the pattern of cancer incidence and determine the incidence rates in Eastern Libya (for the first time in a decade). A hospital-based registry of cancer patients was formed using records from the primary oncology center in eastern Libya - focusing on those diagnosed in the year 2012. The most common malignancies in men were cancers of the colon (22.3%, n = 90), lung (20.3%, n = 82), prostate (16.1%, n = 65), pancreas (4.2%, n = 17) and liver (4.2%, n = 17). For women, they were found to be cancers of the breast (41.5%, n = 213), colon (16.4%, n = 84), uterus (8%, n = 41), ovary (5.5%, n = 28) and pancreas (3.1%, n = 16). Additionally age-standardized rates (ASR) were determined for Libya. The different cities and towns in eastern Libya were compared for any variation. The city of Beida in particular was found to have a remarkably high incidence of gastric cancer. The different findings were discussed and comparisons were made with past literature as well as the incidence rates for neighbouring countries. The incidence rates given for the eastern region showed differences from previously reported values (i.e., the rate of colon cancer was the highest in North Africa whereas other malignancies occurred less frequently). Potential explanations for the urban-rural difference as well as the difference in incidence rates were put forth. The significance of this study is that it establishes a baseline of cancer incidence which should be the backbone for any future national cancer plan in Libya. Proper surveillance programs need to be in place and healthcare policy should be adjusted to take into account the more prevalent and pressing cancers in society.

  8. Thrombocytosis in children at one medical center of southern Taiwan.

    Science.gov (United States)

    Chen, H L; Chiou, S S; Sheen, J M; Jang, R C; Lu, C C; Chang, T T

    1999-01-01

    Thrombocytosis in children is common, but usually without symptoms. The causes of thrombocytosis in children are considered to be mostly due to infection, trauma, surgery, blood disease, prematurity, renal disease and chronic inflammation. To evaluate the incidence and etiology of thrombocytosis of the hospitalized patients, patients who were admitted to the Pediatric Department of Kaohsiung Medical College Hospital (KMCH) from October 1996 to November 1997 were studied. There were 2910 cases studied and 220 cases (127 male and 93 female) had thrombocytosis (> or = 500 x 10(9)/L) with a rate of 7.6%. The causes of thrombocytosis are infections (49.5%), Kawasaki disease (6.4%), postsplenectomy (7.8%), blood diseases (3.7%), malignancies (3.2%), renal disorders (3.2%), prematurity (3.2%), tissue damage (4.5%), chronic inflammation (1.8%), recovery from marrow suppression (1.3%), immunologic disturbances (2.2%), essential thrombocythemia (0.5%), and miscellaneous factors (3.7%). Thrombocytosis associated with multiple, simultaneous causative factors was found in 9.0% of these cases. Thrombocytosis secondary to infectious diseases or Kawasaki disease was significantly more common in children under 2 years old. The most commonly associated infectious disease was respiratory tract infection (61.1%). There were 29 children (13.2%) presenting a platelet count of more than 800,000/mm3. However, no thrombotic complications were seen in any of the children. By far, the major cause of thrombocytosis in our cases was reactive in character. Most of the thrombocytosis cases were due to infections, inflammatory diseases, or Kawasaki disease.

  9. Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance.

    Science.gov (United States)

    Johnson, Bill

    2014-01-01

    Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

  10. Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations

    Directory of Open Access Journals (Sweden)

    Kraus SK

    2017-06-01

    Full Text Available Objectives: To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. Methods: A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Results: Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%, non-formulary omission (16.2%, dose discrepancy (10.1%, and frequency discrepancy (4.1%. Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. Conclusion: A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

  11. The rise of concurrent care for veterans with advanced cancer at the end of life.

    Science.gov (United States)

    Mor, Vincent; Joyce, Nina R; Coté, Danielle L; Gidwani, Risha A; Ersek, Mary; Levy, Cari R; Faricy-Anderson, Katherine E; Miller, Susan C; Wagner, Todd H; Kinosian, Bruce P; Lorenz, Karl A; Shreve, Scott T

    2016-03-01

    Unlike Medicare, the Veterans Health Administration (VA) health care system does not require veterans with cancer to make the "terrible choice" between receipt of hospice services or disease-modifying chemotherapy/radiation therapy. For this report, the authors characterized the VA's provision of concurrent care, defined as days in the last 6 months of life during which veterans simultaneously received hospice services and chemotherapy or radiation therapy. This retrospective cohort study included veteran decedents with cancer during 2006 through 2012 who were identified from claims with cancer diagnoses. Hospice and cancer treatment were identified using VA and Medicare administrative data. Descriptive statistics were used to characterize the changes in concurrent care, hospice, palliative care, and chemotherapy or radiation treatment. The proportion of veterans receiving chemotherapy or radiation therapy remained stable at approximately 45%, whereas the proportion of veterans who received hospice increased from 55% to 68%. The receipt of concurrent care also increased during this time from 16.2% to 24.5%. The median time between hospice initiation and death remained stable at around 21 days. Among veterans who received chemotherapy or radiation therapy in their last 6 months of life, the median time between treatment termination and death ranged from 35 to 40 days. There was considerable variation between VA medical centers in the use of concurrent care (interquartile range, 16%-34% in 2012). Concurrent receipt of hospice and chemotherapy or radiation therapy increased among veterans dying from cancer without reductions in the receipt of cancer therapy. This approach reflects the expansion of hospice services in the VA with VA policy allowing the concurrent receipt of hospice and antineoplastic therapies. Cancer 2016;122:782-790. © 2015 American Cancer Society. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

  12. Medical students' self-perceived competence and prescription of patient-centered physical activity.

    Science.gov (United States)

    Vallance, Jeff K; Wylie, Mark; MacDonald, Randy

    2009-02-01

    The primary objective of this study was to explore medical students' perceptions of their own competence and the importance they assign to patient-centered physical activity (PA) prescription. 246 undergraduate medical students (27% response rate) from two large universities in Western Canada completed an online survey designed to assess their perceived competence and importance related to patient-centered PA prescription. Data collection took place in September and October of 2007. While medical students perceived PA-related prescription to be important (M(response)=26.6 out of 36, SD=5.1), students perceived they had only moderate competence at conducting PA-related prescription (M(response)=20.7 out of 36, SD=6.8). Students achieving national PA guidelines perceived significantly higher competence than students not achieving PA guidelines. Students in their first or second year of medical school perceived PA-related prescription to be of higher importance than students in their third or fourth years. Medical students indicated that patient-centered PA prescription was important. However, they indicated less than moderate competence at performing several fundamental PA prescription behaviors. This study suggests that medical students may not be adequately prepared to dispense patient-centered PA prescriptions with their patients.

  13. Evaluation of intravenous medication errors with smart infusion pumps in an academic medical center

    National Research Council Canada - National Science Library

    Ohashi, Kumiko; Dykes, Patricia; McIntosh, Kathleen; Buckley, Elizabeth; Wien, Matt; Bates, David W

    2013-01-01

    While some published research indicates a fairly high frequency of Intravenous (IV) medication errors associated with the use of smart infusion pumps, the generalizability of these results are uncertain...

  14. Delinquent Medical Service Accounts at Landstuhl Regional Medical Center Need Additional Management Oversight

    Science.gov (United States)

    2016-04-28

    U.S. Army Medical Command, Uniform Business Office, to review, research, and take action as needed on all accounts affected by the implementation of...Army Medical Command (MEDCOM) and Regional Health Command Europe (RHCE) Uniform Business Office (UBO) officials did not effectively manage...to billing weights, which are used to calculate patient charges using diagnosis, risk factors , staff, and equipment; and • MEDCOM UBO officials did

  15. Managing information in the academic medical center: building an integrated information environment.

    Science.gov (United States)

    Fuller, S; Braude, R M; Florance, V; Frisse, M E

    1995-10-01

    The strategic importance of integrated information systems and resources for academic medical centers should not be underestimated. Ten years ago, the National Library of Medicine in collaboration with the Association of Academic Medical Centers initiated the Integrated Advanced Information Management System (IAIMS) program to assist academic medical centers in defining a process for addressing deficiencies in their information environments. The authors give a brief history of the IAIMS program, and they describe both the characteristics of an integrated information environment and the technical and organizational structures necessary to create such an environment. Strategies some institutions have used to implement integrated information systems are also outlined. Finally, the authors discuss the role of librarians in integrated information system design.

  16. Timing of Initiation of Maintenance Dialysis: A Qualitative Analysis of the Electronic Medical Records of a National Cohort of Patients From the Department of Veterans Affairs.

    Science.gov (United States)

    Wong, Susan P Y; Vig, Elizabeth K; Taylor, Janelle S; Burrows, Nilka R; Liu, Chuan-Fen; Williams, Desmond E; Hebert, Paul L; O'Hare, Ann M

    2016-02-01

    There is often considerable uncertainty about the optimal time to initiate maintenance dialysis in individual patients and little medical evidence to guide this decision. To gain a better understanding of the factors influencing the timing of initiation of dialysis in clinical practice. A qualitative analysis was conducted using the electronic medical records from the Department of Veterans Affairs (VA) of a national random sample of 1691 patients for whom the decision to initiate maintenance dialysis occurred in the VA between January 1, 2000, and December 31, 2009. Data analysis took place from June 1 to November 30, 2014. Central themes related to the timing of initiation of dialysis as documented in patients' electronic medical records. Of the 1691 patients, 1264 (74.7%) initiated dialysis as inpatients and 1228 (72.6%) initiated dialysis with a hemodialysis catheter. Cohort members met with a nephrologist during an outpatient clinic visit a median of 3 times (interquartile range, 0-6) in the year prior to initiation of dialysis. The mean (SD) estimated glomerular filtration rate at the time of initiation for cohort members was 10.4 (5.7) mL/min/1.73 m(2). The timing of initiation of dialysis reflected the complex interplay of at least 3 interrelated and dynamic processes. The first was physician practices, which ranged from practices intended to prepare patients for dialysis to those intended to forestall the need for dialysis by managing the signs and symptoms of uremia with medical interventions. The second process was sources of momentum. Initiation of dialysis was often precipitated by clinical events involving acute illness or medical procedures. In these settings, the imperative to treat often seemed to override patient choice. The third process was patient-physician dynamics. Interactions between patients and physicians were sometimes adversarial, and physician recommendations to initiate dialysis sometimes seemed to conflict with patient priorities

  17. A descriptive analysis of medical health services utilization of Veterans living in Ontario: a retrospective cohort study using administrative healthcare data.

    Science.gov (United States)

    Aiken, Alice B; Mahar, Alyson L; Kurdyak, Paul; Whitehead, Marlo; Groome, Patti A

    2016-08-04

    Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system. This is a retrospective cohort study designed to use Ontario's provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release. The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1-83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0-61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2-41.5) went to the emergency department in that same time period and 9.9 % (9.5-10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity. This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.

  18. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

    Directory of Open Access Journals (Sweden)

    Olga Moshkovich

    2015-01-01

    Full Text Available Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen’s Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

  19. Engagement in mental health treatment among veterans returning from Iraq

    Directory of Open Access Journals (Sweden)

    Tracy Stecker

    2010-03-01

    Full Text Available Tracy Stecker1,2, John Fortney3,4, Francis Hamilton1,2, Cathy D Sherbourne5, Icek Ajzen61Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH, USA; 2VA Health Services Research and Development, White River Junction Veterans Administration, White River Junction, VT, USA; 3VA Health Services Research and Development (HR S&D, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA; 4Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 5RAND, Santa Monica, CA, USA; 6Department of Psychology, University of Massachusetts, Amherst, MA, USAObjectives: Many veterans return from combat experiencing a variety of mental health concerns. Previous research has documented a stigma associated with seeking treatment that interferes with the decision to seek treatment. This study, conceptualized using the theory of planned behavior, assessed beliefs about mental health treatment in order to understand mental health treatment seeking behavior among a group of returning National Guard soldiers who served in the war in Iraq.Methods: Participants were one hundred and fifty Operation Iraqi Freedom National Guard soldiers who screened positive for depression, posttraumatic stress disorder, generalized anxiety disorder, panic disorder or alcohol abuse disorder on the Mini International Neuropsychiatric Interview (MINI. Participants were asked to complete a questionnaire assessing beliefs about mental health treatment and treatment-seeking behavior.Results: Beliefs related to symptom reduction and work were significantly related to mental health treatment-seeking behavior. Conclusions: Interventions developed to engage veterans into care must be directed toward cognitive factors that motivate treatment seeking in addition to traditionally targeted structural barriers.Keywords: treatment

  20. 2007 Veterans Employability Research Survey

    Data.gov (United States)

    Department of Veterans Affairs — The 2007 Veterans Employability Research Survey (VERS) was conducted to determine the factors that impact veterans' employability resulting from participation in the...

  1. Results of an Institutional LGBT Climate Survey at an Academic Medical Center.

    Science.gov (United States)

    Chester, Sean D; Ehrenfeld, Jesse M; Eckstrand, Kristen L

    2014-12-01

    The purpose of this study was to characterize the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center. An anonymous, online institutional climate survey was used to assess the attitudes and experiences of LGBT employees and students. There were 42 LGBT and 14 non-LGBT survey participants. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain "closeted" and were harassed despite medical center policies of non-discrimination. Continuing training, inclusive policies and practices, and the development of mechanisms to address LGBT-specific harassment are necessary for improving institutional climate.

  2. Business Case Analysis of the Walter Reed Army Medical Center Medical/Surgical Prime Vendor Generation III Service Level Electron Program

    National Research Council Canada - National Science Library

    Markot, Peter B

    2007-01-01

    ...) staffing and medical/surgical services offered under the Prime Vendor (PV) Generation III contract would provide the best supply chain management solution for Walter Reed Army Medical Center (WRAMC...

  3. The Application of Strategic Planning Tools for Enhanced Palliative Care Services at the Minneapolis Veterans Affairs Medical Center

    National Research Council Canada - National Science Library

    Mylan, Marci M

    2005-01-01

    .... Using selected strategic planning tools, the study examined the gaps in services by gathering staff opinions, examining local statistics regarding end-of-life care, and looking at community and national trends...

  4. Can Japanese students embrace learner-centered methods for teaching medical interviewing skills? Focus groups.

    Science.gov (United States)

    Saiki, Takuya; Mukohara, Kei; Otani, Takashi; Ban, Nobutaro

    2011-01-01

    Students' perceptions of learner-centered methods for teaching medical interviewing skills have not been fully explored. To explore Japanese students' perceptions of learner-centered methods for teaching medical interviewing skills such as role play with student-created scenarios, peer-assisted video reviews, and student-led small group debriefing. We conducted three focus groups with a total of 15 students who participated in the learner-centered seminars on medical interviewing skills at the Nagoya University School of Medicine. The transcripts were analyzed by two authors independently. Keywords and concepts were identified and a thematic framework was developed. Overall, students valued the experience of writing their own scenarios for role play, but some questioned their realism. Many students commented that peer-assisted video reviews provided them with more objective perspectives on their performance. However, some students expressed concerns about competitiveness during the video reviews. While students appreciated teachers' minimum involvement in the group debriefing, some criticized that teachers did not explain the objectives of the seminar clearly. Many students had difficulties in exchanging constructive feedback. We were able to gain new insights into positive and negative perceptions of students about learner-centered methods for teaching medical interviewing skills at one medical school in Japan.

  5. Improving the transition of care in patients transferred through the ochsner medical center transfer center.

    Science.gov (United States)

    Amedee, Ronald G; Maronge, Genevieve F; Pinsky, William W

    2012-01-01

    Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (Pkaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects.

  6. Hysterectomy risk in premenopausal-aged military veterans: associations with sexual assault and gynecologic symptoms.

    Science.gov (United States)

    Ryan, Ginny L; Mengeling, Michelle A; Summers, Karen M; Booth, Brenda M; Torner, James C; Syrop, Craig H; Sadler, Anne G

    2016-03-01

    Several gynecological conditions associated with hysterectomy, including abnormal bleeding and pelvic pain, have been observed at increased rates in women who have experienced sexual assault. Previous findings have suggested that one of the unique health care needs for female military veterans may be an increased prevalence of hysterectomy and that this increase may partially be due to their higher risk of sexual assault history and posttraumatic stress disorder (PTSD). Although associations between trauma, PTSD, and gynecological symptoms have been identified, little work has been done to date to directly examine the relationship between sexual assault, PTSD, and hysterectomy within the rapidly growing female veteran population. The objective of the study was to assess the prevalence of hysterectomy in premenopausal-aged female veterans, compare with general population prevalence, and examine associations between hysterectomy and sexual assault, PTSD, and gynecological symptoms in this veteran population. We performed a computer-assisted telephone interview between July 2005 and August 2008 of 1004 female Veterans Affairs (VA)-enrolled veterans ≤ 52 years old from 2 Midwestern US Veterans Affairs medical centers and associated community-based outreach clinics. Within the veteran study population, associations between hysterectomy and sexual assault, PTSD, and gynecological symptoms were assessed with bivariate analyses using χ(2), Wilcoxon-Mann-Whitney, and Student t tests; multivariate logistic regression analyses were used to look for independent associations. Hysterectomy prevalence and ages were compared with large civilian populations represented in the Behavioral Risk Factor Surveillance System and American College of Surgeons National Surgical Quality Improvement Program databases from similar timeframes using χ(2) and Student t tests. Prevalence of hysterectomy was significantly higher (16.8% vs 13.3%, P = .0002), and mean age at hysterectomy was

  7. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Data VA App Store National Resource Directory Grants Management Services Veterans Service Organizations Office of Accountability & Whistleblower ... Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen ...

  8. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... All Measures Treatment Treatment Overview Early Intervention Veterans Cultural Considerations Women Children Older Adults Working with Families ... Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen ...

  9. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Performance VA Plans, Budget, & Performance VA Center for Innovation (VACI) Agency Financial Report (AFR) Budget Submission Recovery ... Home Apply for VA Care Apply Online Application Process Veteran Eligibility Active Duty Families of Veterans Women ...

  10. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen Service (VCS) Research Research Home About VA Research Services Programs News, Events and Media Research Topics For Veterans For Researchers ...

  11. A division of medical communications in an academic medical center's department of medicine.

    Science.gov (United States)

    Drazen, Jeffrey M; Shields, Helen M; Loscalzo, Joseph

    2014-12-01

    Excellent physician communication skills (physician-to-patient and patient-to-physician) have been found to have a positive impact on patient satisfaction and may positively affect patient health behaviors and health outcomes. Such skills are also essential for accurate, succinct, and clear peer-to-peer (physician-to-physician), physician-to-lay-public, and physician-to-media communications. These skills are not innate, however; they must be learned and practiced repeatedly. The Division of Medical Communications (DMC) was created within the Department of Medicine at Brigham and Women's Hospital as an intellectual home for physicians who desire to learn and teach the wide variety of skills needed for effective communication.In this Perspective, the authors provide an overview of the key types of medical communications and share the DMC model as an innovative approach to providing expert guidance to physicians and physicians-in-training as they develop, practice, and refine their communication skills. Current DMC projects and programs include a Volunteer Patient Teaching Corps, which provides feedback to medical students, residents, and faculty on communication skills; a controlled trial of a modified team-based learning method for attending rounds; expert coaching in preparation for presentations of all types (e.g., grand rounds; oral presentations or poster presentations on basic science, clinical, or medical education research); sessions on speaking to the media and running a meeting well; and courses on writing for publication. Objective assessment of the impact of each of these interventions is planned.

  12. Delinquent Medical Service Accounts at David Grant Air Force Medical Center Need Additional Management Oversight

    Science.gov (United States)

    2015-09-24

    for children and adults with limited income and resources. ...did not elevate reimbursement problems with Medicare and Coalition Forces patients...stating that DoD 6010.15-M is available to DGMC UBO staff on the DHA website. In addition, the Air Force Medical Operations Agency and AF/SG UBO

  13. A Human-Centered Approach to Medical Informatics for Medical Students, Residents, and Practicing Clinicians.

    Science.gov (United States)

    Stahlhut, Richard W.; Gosbee, John W.; Gardner-Bonneau, Daryle J.

    1997-01-01

    Describes development of a curriculum in medical information science that focuses on practical problems in clinical medicine rather than details of information technology. Design was guided by identification of six key clinical challenges that must be addressed by practitioners in the near future and by examination of past failures of informatics…

  14. Medical student socio-demographic characteristics and attitudes toward patient centered care: do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study.

    Science.gov (United States)

    Hardeman, Rachel R; Burgess, Diana; Phelan, Sean; Yeazel, Mark; Nelson, David; van Ryn, Michelle

    2015-03-01

    To determine whether attitudes toward patient-centered care differed by socio-demographic characteristics (race, gender, socioeconomic status) among a cohort of 3191 first year Black and White medical students attending a stratified random sample of US medical schools. This study used baseline data from Medical Student CHANGES, a large national longitudinal cohort study of medical students. Multiple logistic regression was used to assess the association of race, gender and SES with attitudes toward patient-centered care. Female gender and low SES were significant predictors of positive attitudes toward patient-centered care. Age was also a significant predictor of positive attitudes toward patient-centered care such that students older than the average age of US medical students had more positive attitudes. Black versus white race was not associated with attitudes toward patient-centered care. New medical students' attitudes toward patient-centered care may shape their response to curricula and the quality and style of care that they provide as physicians. Some students may be predisposed to attitudes that lead to both greater receptivity to curricula and the provision of higher-quality, more patient-centered care. Medical school curricula with targeted messages about the benefits and value of patient-centered care, framed in ways that are consistent with the beliefs and world-view of medical students and the recruitment of a socioeconomically diverse sample of students into medical schools are vital for improved care. Published by Elsevier Ireland Ltd.

  15. Honoring our Nation's Veterans

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-11-01

    Full Text Available No abstract available. Article truncated at 150 words. Today is Armistice Day, renamed Veterans Day in 1954, to honor our Nation's Veterans. In Washington the rhetoric from both the political right and left supports our Veterans. My cynical side reminds me that this might have something to do with Veterans voting in a higher percentage than the population as a whole, but let me give the politicians this one. Serving our Country in the military is something that deserves to be honored. I was proud to serve our Veterans over 30 years at the four Department of Veterans Affairs (VA hospitals. However, the VA has had a very bad year. First, in Washington there were the resignations of the Secretary of Veterans Affairs, Eric Shinseki; the undersecretary for the Veterans Health Administration, Robert Petzel; and the undersecretary for the Veterans Benefits Administration, Allison Hickey. Locally, in the light of the VA wait scandal there were the firing of ...

  16. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Media Research Topics For Veterans For Researchers Research Oversight Special Groups Caregivers Combat Veterans & their Families Readjustment ... DOD Clinical Practice Guidelines Access and Quality Data Medical Inspector Patient Safety Organizations Administrative Clinical Quick Links ...

  17. Involvement of Pharmacists in Medical Care in Emergency and Critical Care Centers.

    Science.gov (United States)

    Imai, Toru; Yoshida, Yoshikazu

    2016-01-01

    Emergency and critical care centers provide multidisciplinary therapy for critically ill patients by centralizing the expertise and technology of many medical professionals. Because the patients' conditions vary, different drug treatments are administered along with surgery. Therefore, the role of pharmacists is important. Critically ill patients who receive high-level invasive treatment undergo physiological changes differing from their normal condition along with variable therapeutic effects and pharmacokinetics. Pharmacists are responsible for recommending the appropriate drug therapy using their knowledge of pharmacology and pharmacokinetics. Further, pharmacists need to determine the general condition of patients by understanding vital signs, blood gas analysis results, etc. It is therefore necessary to conduct consultations with physicians and nurses. The knowledge required for emergency medical treatment is not provided during systematic training in pharmaceutical education, meaning that pharmacists acquire it in the clinical setting through trial and error. To disseminate the knowledge of emergency medical care to pharmacy students, emergency care training has been started in a few facilities. I believe that medical facilities and universities need to conduct joint educational sessions on emergency medical care. Moreover, compared with other medical fields, there are fewer studies on emergency medical care. Research-oriented pharmacists must resolve this issue. This review introduces the work conducted by pharmacists for clinical student education and clinical research at the Emergency and Critical Care Center of Nihon University Itabashi Hospital and discusses future prospects.

  18. Evolution and Integration of Medical Laboratory Information System in an Asia National Medical Center

    Science.gov (United States)

    Cheng, Po-Hsun; Chen, Sao-Jie; Lai, Jin-Shin

    This work elucidates the evolution of three generations of the laboratory information system in the National Taiwan University Hospital, which were respectively implemented in an IBM Series/1 mini-computer, a client/server and a plug-and-play HL7 interface engine environment respectively. The experience of using the HL7 healthcare information exchange in the hospital information system, laboratory information system, and automatic medical instruments over the past two decades are illustrated and discussed. The latest design challenge in developing intelligent laboratory information services is to organize effectively distributed and heterogeneous medical instruments through the message gateways. Such experiences had spread to some governmental information systems for different purposes in Taiwan; besides, the healthcare information exchange standard, software reuse mechanism, and application service provider adopted in developing the plug-and-play laboratory information system are also illustrated.

  19. An Investigation of the Medical Record Processing System at Walter Reed Army Medical Center

    Science.gov (United States)

    1991-12-01

    are on the wards. Until recently, the MRTs with this responsibility were part of the Directorate of Medical Activities Administration ( DMAA ). They...performed the general missions assigned by the DMAA and responded to day-to- day duty assignments on the nursing ward. There wis a potential for...conflicting priorities under these conditions. For these reasons and many others (Patillo, 1990) the DMAA was reorganized and the MRTs were integrated into

  20. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience.

    Science.gov (United States)

    Thomas-Hemak, Linda; Palamaner Subash Shantha, Ghanshyam; Gollamudi, Lakshmi Rani; Sheth, Jignesh; Ebersole, Brian; Gardner, Katlyn J; Nardella, Julie; Ruddy, Meaghan P; Meade, Lauren

    2015-01-01

    Purpose. The effect of patient centered medical home (PCMH) curriculum interventions on residents' self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA) is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents. Methods. Twenty four (24) Internal Medicine residents-12 Traditional (TR) track residents and 12 Teaching Health Center (THC) track residents-began training in Academic Year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents. Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance. Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA's) Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents.

  1. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

    Directory of Open Access Journals (Sweden)

    Linda Thomas-Hemak

    2015-02-01

    Full Text Available Purpose. The effect of patient centered medical home (PCMH curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents.Methods. Twenty four (24 Internal Medicine residents—12 Traditional (TR track residents and 12 Teaching Health Center (THC track residents—began training in Academic Year (AY 2011 at the Wright Center for Graduate Medical Education (WCGME. They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents.Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance.Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents.

  2. Building Brains, Forging Futures: A Call to Action for the Family-Centered Medical Home

    Science.gov (United States)

    Kraft, Colleen

    2013-01-01

    The family-centered medical home describes an approach to providing comprehensive primary care. Research advances in developmental neuroscience, genetics, and epigenetics offer a framework for understanding the dynamic process of brain development. It is this process that sets the life-course trajectory for an individual; in turn, a child's…

  3. Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology

    Science.gov (United States)

    The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology (CMAVE) has a history that starts in 1932 in Orlando to develop methods to control mosquitoes, including malaria vectors under conditions simulating those of the south Pacific jungles, and other insects affecting man and animals...

  4. Which Sexual Abuse Victims Receive a Forensic Medical Examination?: The Impact of Children's Advocacy Centers

    Science.gov (United States)

    Walsh, Wendy A.; Cross, Theodore P.; Jones, Lisa M.; Simone, Monique; Kolko, David J.

    2007-01-01

    Objective: This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. Methods: This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of…

  5. Positioning academic medical centers and teaching hospitals to thrive in the next decade.

    Science.gov (United States)

    Morris, D E

    1985-06-01

    Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification.

  6. Research Strategies for Academic Medical Centers: A Framework for Advancements toward Translational Excellence

    Science.gov (United States)

    Haley, Rand; Champagne, Thomas J., Jr.

    2017-01-01

    This review article presents a simplified framework for thinking about research strategy priorities for academic medical centers (AMCs). The framework can serve as a precursor to future advancements in translational medicine and as a set of planning guideposts toward ultimate translational excellence. While market pressures, reform uncertainties,…

  7. The History of SHSAAMc: Student Health Services at Academic Medical Centers

    Science.gov (United States)

    Veeser, Peggy Ingram; Hembree, Wylie; Bonner, Julia

    2008-01-01

    This article presents an historical review of the organization known as Student Health Services at Academic Medical Centers (SHSAAMc). The authors discuss characteristics of health service directors as well as the history of meetings, discussion, and leadership. The focus of the group is the healthcare needs of health professions students at…

  8. Developing a Sustainable Research Culture in an Independent Academic Medical Center

    Science.gov (United States)

    Joyce, Jeffrey N.

    2013-01-01

    Independent academic medical centers (IAMC) are challenged to develop and support a research enterprise and maintain primary goals of healthcare delivery and financial solvency. Strategies for promoting translational research have been shown to be effective at institutions in the top level of federal funding, but not for smaller IAMCs. The…

  9. Developing physician leaders in academic medical centers. Part 1: Their changing role.

    Science.gov (United States)

    Bachrach, D J

    1996-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.

  10. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

    Science.gov (United States)

    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  11. Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis.

    Science.gov (United States)

    Gao, Yue; Nocon, Robert S; Gunter, Kathryn E; Sharma, Ravi; Ngo-Metzger, Quyen; Casalino, Lawrence P; Chin, Marshall H

    2016-09-01

    The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. To identify characteristics associated with HCs' PCMH capability. Cross-sectional analysis of a national dataset of Federally Qualified Health Centers (FQHCs) in 2009. Data for PCMH capability, HC, patient, neighborhood, and regional characteristics were combined from multiple sources. A total of 706 (70 %) of 1014 FQHCs from the Health Resources and Services Administration Community Health Center Program, representing all 50 states and the District of Columbia. PCMH capability was scored via the Commonwealth Fund National Survey of FQHCs through the Safety Net Medical Home Scale (0 [worst] to 100 [best]). HC, patient, neighborhood, and regional characteristics (all analyzed at the HC level) were measured from the Commonwealth survey, Uniform Data System, American Community Survey, American Medical Association physician data, and National Academy for State Health Policy data. Independent correlates of high PCMH capability included having an electronic health record (EHR) (11.7-point [95 % confidence interval, CI 10.2-13.3]), more types of financial performance incentives (0.7-point [95 % CI 0.2-1.1] higher total score per one additional type, maximum possible = 10), more types of hospital-HC affiliations (1.6-point [95 % CI 1.1-2.1] higher total score per one additional type, maximum possible = 6), and location in certain US census divisions. Among HCs with an EHR, location in a state with state-supported PCMH initiatives and PCMH payments was associated with high PCMH capability (2.8-point, 95 % CI 0.2-5.5). Other characteristics had small effect size based on the measure unit (e.g. 0.04-point [95 % CI 0-0.08] lower total score per one percentage point more minority patients), but the effects could be practically large at the extremes. EHR adoption likely played a role in HCs' improvement in PCMH

  12. Evaluation of medication adherence in chronic disease at a federally qualified health center.

    Science.gov (United States)

    Oung, Alvin B; Kosirog, Emily; Chavez, Benjamin; Brunner, Jason; Saseen, Joseph J

    2017-08-01

    While medication adherence in chronic disease has been evaluated in the general population, limited data are available among Medicaid recipients, especially within federally qualified health centers (FQHCs). This study determined baseline medication adherence for Medicaid recipients receiving care in an FQHC for first-line medications used in hypertension, hyperlipidemia, and diabetes. Secondary outcomes included baseline adherence for individual patient factors. Patients from the Salud Family Health Centers, an FQHC with a large percentage of both Spanish-speaking patients and providers, were included in this study. Using retrospective prescription claims reports from 1 January 2015 to 1 October 2015, medication possession ratios (MPRs) and proportion of days covered (PDC) were calculated for each medication group. Patients with adherence ⩾0.80 were considered adherent. From 1034 individual patients, 1788 medications were evaluated. Using MPRs, adherence rates were highest among medications for hypertension (67.2% adherent), followed by hyperlipidemia (67.0%), and lastly diabetes (58.0%); p adherence rates were highest for medications for hypertension (56.6%), followed by hyperlipidemia (52.2%), and lastly diabetes (45.0%); p = 0.010. Lower rates of adherence were seen among men, patients age 18-29 years old, African Americans, and patients with English documented as their preferred language. Although overall medication adherence rates within our FQHC patients were comparable with those in previous literature, differences seen among medication groups and patient individual factors suggest that there is still much to be learned in improving adherence. Future efforts will require a multifaceted approach, tailored to patient-specific needs.

  13. The economic impact and multiplier effect of a family practice clinic on an academic medical center.

    Science.gov (United States)

    Schneeweiss, R; Ellsbury, K; Hart, L G; Geyman, J P

    1989-07-21

    Academic medical centers are facing the need to expand their primary care referral base in an increasingly competitive medical environment. This study describes the medical care provided during a 1-year period to 6304 patients registered with a family practice clinic located in an academic medical center. The relative distribution of primary care, secondary referrals, inpatient admissions, and their associated costs are presented. The multiplier effect of the primary care clinic on the academic medical center was substantial. For every $1 billed for ambulatory primary care, there was $6.40 billed elsewhere in the system. Each full-time equivalent family physician generated a calculated sum of $784,752 in direct, billed charges for the hospital and $241,276 in professional fees for the other specialty consultants. The cost of supporting a primary care clinic is likely to be more than offset by the revenues generated from the use of hospital and referral services by patients who received care in the primary care setting.

  14. Prevalence of Unplanned Hospitalizations Caused by Adverse Drug Reactions Among Older Veterans

    Science.gov (United States)

    Marcum, Zachary A.; Amuan, Megan E.; Hanlon, Joseph T.; Aspinall, Sherrie L.; Handler, Steven M.; Ruby, Christine M.; Pugh, Mary Jo V.

    2011-01-01

    Objectives To describe the prevalence of unplanned hospitalizations caused by ADRs among older Veterans and examine the association between this outcome and polypharmacy after controlling for comorbidities and other patient characteristics. Design Retrospective cohort. Setting Veterans Affairs Medical Centers (VAMC). Participants 678 randomly selected unplanned hospitalizations of older (age ≥ 65 years) Veterans between 10/01/03 and 09/30/06. Measurements Naranjo ADR algorithm, ADR preventability, and polypharmacy (0–4, 5–8, and ≥ 9 scheduled medications). Results Seventy ADRs involving 113 drugs were determined in 68 (10%) older Veterans’ hospitalizations, of which 36.8% (25/68) were preventable. Extrapolating to the population of over 2.4 million older Veterans receiving care during the study period, 8,000 hospitalizations may have been unnecessary. The most common ADRs that occurred were bradycardia (n=6; beta blockers, digoxin), hypoglycemia (n=6; sulfonylureas, insulin), falls (n=6; antidepressants, ACE-inhibitors), and mental status changes (n=6; anticonvulsants, benzodiazepines). Overall, 44.8% of Veterans took ≥ 9 outpatient medications and 35.4% took 5–8. Using multivariable logistic regression and controlling for demographic, health status, and access to care variables, polypharmacy (≥ 9 and 5–8) was associated with an increased risk of ADR-related hospitalization (AOR 3.90, 95% CI 1.43–10.61 and AOR 2.85, 95% CI 1.03–7.85, respectively). Conclusion ADRs determined by a validated causality algorithm are a common cause of unplanned hospitalization among older Veterans, are frequently preventable, and are associated with polypharmacy. PMID:22150441

  15. P-50the prevalence of seizures during withdrawal from alcohol, benzodiazepines and opiates in medically monitored detoxification center

    National Research Council Canada - National Science Library

    Poluha, W

    2014-01-01

    .... Medically monitored detoxification centers admit patients with known history of withdrawal seizures as well as history of seizure disorders for detoxification from alcohol benzodiazepines and opioids...

  16. Global trends in center accreditation by the Joint Commission International: growing patient implications for international medical and surgical care.

    Science.gov (United States)

    Mehta, Ambar; Goldstein, Seth D; Makary, Martin A

    2017-09-01

    Millions of patients travel internationally for medical and surgical care. We found that the annual number of centers accredited by the Joint Commission International increased from one center in 1999 to 132 centers in 2016; there are currently 939 accredited centers across 66 countries. Public health and medicolegal implications related to medical travel deserve attention. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  17. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.

    Science.gov (United States)

    Street, Richard L; Liu, Lin; Farber, Neil J; Chen, Yunan; Calvitti, Alan; Zuest, Danielle; Gabuzda, Mark T; Bell, Kristin; Gray, Barbara; Rick, Steven; Ashfaq, Shazia; Agha, Zia

    2014-09-01

    The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower in patient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously

  18. Provider interaction with the electronic health record: The effects on patient-centered communication in medical encounters

    Science.gov (United States)

    Street, Richard L.; Liu, Lin; Farber, Neil J.; Chen, Yunan; Calvitti, Alan; Zuest, Danielle; Gabuzda, Mark T.; Bell, Kristin; Gray, Barbara; Rick, Steven; Ashfaq, Shazia; Agha, Zia

    2015-01-01

    Objective The computer with the electronic health record (EHR) is an additional ‘interactant’ in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Methods Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. Results The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower inpatient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. Conclusions PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can

  19. Driving Simulator Performance of Veterans from the Iraq and Afghanistan Wars

    Science.gov (United States)

    2013-01-01

    Asleep at the wheel: The prevalence and impact of drowsy driving . Washington (DC): AAA Foundation for Traffic Safety; 2010. 11. National Highway Traffic...463 JRRD Volume 50, Number 4, 2013Pages 463–470 Driving simulator performance of Veterans from the Iraq and Afghanistan wars Melissa M. Amick, PhD;1...Clinical Center, VA Boston Healthcare System, Boston, MA; and Department of Psychology, Harvard Medical School, Boston, MA Abstract— Driving simulator

  20. My personal experiences at the BEST Medical Center: A day in the clinic-the afternoon.

    Science.gov (United States)

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who recently began her new faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. After completing her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School), she did her internal medicine residency and fellowship training at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. Her morning in gastroenterology clinic was highlighted by: (1) being reprimanded by the clinic nurse manager for a patient who not only arrived early, before clinic had opened, but also neglected to schedule the anesthesiologist for his colonoscopy; (2) the continued challenges of LEGEND (also known as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues), the new electronic medical record system after the BEST discarded the SIMPLE (Succinct Input Making Patient's Lives Electronic) system; (3) a nurse's interruption of an office visit-once the egg timer on the examination room door ran out-because she had exceeded the allocated time for the appointment; and (4) her chairman's unanticipated arrival in the clinic to visit with the clinic nurse manager. In addition to seeing her patients, Dr. Lystic's afternoon is occupied by attending a LOST (Laboratory OverSight and Testing) Committee meeting and a visit from a wayfinding and signage specialist to depersonalize the doorpost plaques of the examination rooms. Her day ends with a demeaning email from her chairman regarding the poor results of the most recent patient satisfaction survey and being personally held accountable to develop solutions to improve not only her performance but also that of the clinic. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes mentioned in this essay are based on individual patients and their physicians, clinics in medical centers and their administration

  1. Unlocking the black box: supporting practices to become patient-centered medical homes.

    Science.gov (United States)

    Coleman, Katie; Phillips, Kathryn E; Van Borkulo, Nicole; Daniel, Donna M; Johnson, Karin E; Wagner, Edward H; Sugarman, Jonathan R

    2014-11-01

    Despite widespread interest in supporting primary care transformation, few evidence-based strategies for technical assistance exist. The Safety Net Medical Home Initiative (SNMHI) sought to develop a replicable and sustainable model for Patient-centered Medical Home practice transformation. This paper describes the multimodal technical assistance approach used by the SNMHI and the participating practices' assessment of its value and helpfulness in supporting their transformation. Components of the technical assistance framework included: (1) individual site-level coaching provided by local medical home facilitators and supplemented by expert consultation; (2) regional and national learning communities of participating practices that included in-person meetings and field trips; (3) data monitoring and feedback including longitudinal feedback on medical home implementation as measured by the Patient-centered Medical Home-A; (4) written implementation guides, tools, and webinars relating to each of the 8 Change Concepts for Practice Transformation; and (5) small grant funds to support infrastructure and staff development. Overall, practices found the technical assistance helpful and most valued in-person, peer-to-peer-learning opportunities. Practices receiving technical assistance from membership organizations with which they belonged before the SNMHI scored higher on measures of medical home implementation than practices working with organizations with whom they had no prior relationship. There is an important role for both local and national organizations to provide nonduplicative, mutually reinforcing support for primary care transformation. How (in-person, between-peers) and by whom technical assistance is provided may be important to consider.

  2. On Becoming a Humanities Curriculum: the Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio.

    Science.gov (United States)

    Jones, Therese; Verghese, Abraham

    2003-10-01

    The authors describe the development and implementation of a new longitudinal and integrated humanities curriculum in the School of Medicine at the University of Texas Health Science Center at San Antonio. Included are a history of ethics and humanities education in the medical school leading to the creation of the Center for Medical Humanities and Ethics in July 2002; an articulation of the Center's basic principles; a curricular blueprint outlining the core objectives and methodologies, such as a narrative approach of this required, four-year humanities curriculum for undergraduate medical students; and an overview of course materials and activities.

  3. Integrating complementary and alternative medicine into academic medical centers: Experience and perceptions of nine leading centers in North America

    Directory of Open Access Journals (Sweden)

    Waters Kellie

    2005-12-01

    Full Text Available Background Patients across North America are using complementary and alternative medicine (CAM with increasing frequency as part of their management of many different health conditions. The objective of this study was to develop a guide for academic health sciences centers that may wish to consider starting an integrative medicine program. Methods We queried North American leaders in the field of integrative medicine to identify initial sites. Key stakeholders at each of the initial sites visited were then asked to identify additional potential study sites (snowball sampling, until no new sites were identified. We conducted structured interviews to identify critical factors associated with success and failure in each of four domains: research, education, clinical care, and administration. During the interviews, field notes were recorded independently by at least two investigators. Team meetings were held after each visit to reach consensus on the information recorded and to ensure that it was as complete as possible. Content analysis techniques were used to identify key themes that emerged from the field notes. Results We identified ten leading North American integrative medical centers, and visited nine during 2002–2003. The centers visited suggested that the initiation of an integrative medicine program requires a significant initial outlay of funding and a motivated "champion". The centers had important information to share regarding credentialing, medico-legal issues and billing for clinical programs; identifying researchers and research projects for a successful research program; and strategies for implementing flexible educational initiatives and establishing a functional administrative structure. Conclusion Important lessons can be learned from academic integrative programs already in existence. Such initiatives are timely and feasible in a variety of different ways and in a variety of settings.

  4. 78 FR 76061 - Authorization for Non-VA Medical Services

    Science.gov (United States)

    2013-12-16

    ....009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental Care... Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64.018, Sharing Specialized Medical Resources; 64... furnished hospital care, nursing home care, domiciliary care, or medical services, and requires medical...

  5. Homeless veterans' experiences with substance use, recovery, and treatment through photo elicitation.

    Science.gov (United States)

    Sestito, Samuel F; Rodriguez, Keri L; Saba, Shaddy K; Conley, James W; Mitchell, Michael A; Gordon, Adam J

    2017-01-01

    Homeless veterans often have addictions and comorbidities that complicate utilization of longitudinal health care services, such as primary care. An understanding of experiences of veterans enrolled in a Homeless Patient Aligned Care Team (H-PACT) may improve addiction treatment engagement in these settings. The authors aimed to describe H-PACT veterans' experiences with substance use (SU), substance use recovery (SUR), and substance use treatment (SUT). Homeless veterans were recruited from a veteran primary care medical home clinic between September 2014 and March 2015. Twenty veterans were given digital cameras and prompts for taking photographs about their health and health care and participated in 2 photo elicitation interviews. For this secondary analysis, transcripts from the audio-recorded interviews were analyzed by 2 coders using qualitative content analysis. The majority of participants (75%, n = 15) discussed SU, SUR, and/or SUT in regards to their health and health care utilization. SU themes centered on disclosure of addiction or dependency; substances used; repercussions of SU; SU as a coping mechanism; and association of SU with military service. SUR themes included disclosure of length of sobriety; perceived facilitators of SUR in health, beliefs, social, environmental, financial, and creative pursuit domains; and perceived barriers to SUR in beliefs, social, and environmental domains. SUT themes focused on perceived facilitators of SUT in access to Department of Veterans Affairs (VA) and non-VA services and social domains and perceived barriers to SUT in the social domain. Providers seeking to elicit addiction-related clinical history and facilitate SUR and SUT might look to the current findings for guidance. Provider training in motivational interviewing may be warranted, which allows for an exploration of health-related consequences of SU and supports patients' self-efficacy.

  6. Diet quality is associated with mental health, social support, and neighborhood factors among Veterans.

    Science.gov (United States)

    Hoerster, Katherine D; Wilson, Sarah; Nelson, Karin M; Reiber, Gayle E; Masheb, Robin M

    2016-12-01

    United States Veterans have a higher prevalence of overweight and related chronic conditions compared to the general population. Although diet is a primary and modifiable contributor to these conditions, little is known about factors influencing diet quality among Veterans. The goal of this study is to examine individual, social environment, and physical environment correlates of general diet quality among Veterans. Study participants (N=653) received care at an urban VA Medical Center in Seattle, WA and completed a mailed survey in 2012 and 2013. Diet quality was assessed with Starting the Conversation, an instrument that measures consumption of unhealthy snacks, fast food, desserts, sugar-sweetened beverages, and fats; fruits and vegetables; and healthy proteins. Variables significantly (p<0.05) associated with diet quality in bivariate analyses were included in a multivariate regression. In the multivariate model, higher level of depressive symptom severity (Diff=0.05; CI=0.01, 0.09; p=0.017); not having others eat healthy meals with the Veteran (Diff=-0.81; CI=-1.5, -0.1; p=0.022); and reduced availability of low-fat foods in neighborhood stores where the Veteran shops (Diff=-0.37; CI=-0.6, -0.2; p<0.001) were associated with poorer diet quality. Consistent with prior research in the general population, this study identified multiple domains associated with Veterans' diet quality, including psychological comorbidity, the social environment, and the physical environment. Findings from this study suggest that interventions aimed at mental health, social support, and neighborhood access to healthy foods are needed to improve Veteran diet quality. Published by Elsevier Ltd.

  7. Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout.

    Science.gov (United States)

    Fischer, Melanie S; Bhatia, Vickie; Baddeley, Jenna L; Al-Jabari, Rawya; Libet, Julian

    2017-07-28

    Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence-based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the "active" treatment stage after the 3-4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non-Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non-Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment. © 2017 Family Process Institute.

  8. Towards Interactive Medical Content Delivery Between Simulated Body Sensor Networks and Practical Data Center.

    Science.gov (United States)

    Shi, Xiaobo; Li, Wei; Song, Jeungeun; Hossain, M Shamim; Mizanur Rahman, Sk Md; Alelaiwi, Abdulhameed

    2016-10-01

    With the development of IoT (Internet of Thing), big data analysis and cloud computing, traditional medical information system integrates with these new technologies. The establishment of cloud-based smart healthcare application gets more and more attention. In this paper, semi-physical simulation technology is applied to cloud-based smart healthcare system. The Body sensor network (BSN) of system transmit has two ways of data collection and transmission. The one is using practical BSN to collect data and transmitting it to the data center. The other is transmitting real medical data to practical data center by simulating BSN. In order to transmit real medical data to practical data center by simulating BSN under semi-physical simulation environment, this paper designs an OPNET packet structure, defines a gateway node model between simulating BSN and practical data center and builds a custom protocol stack. Moreover, this paper conducts a large amount of simulation on the real data transmission through simulation network connecting with practical network. The simulation result can provides a reference for parameter settings of fully practical network and reduces the cost of devices and personnel involved.

  9. Veterans and Homelessness

    National Research Council Canada - National Science Library

    Perl, Libby

    2007-01-01

    .... The Department of Veterans Affairs (VA) estimates that it has served approximately 300 returning veterans in its homeless programs and has identified over 1,000 more as being at risk of homelessness...

  10. For Homeless Veterans

    Science.gov (United States)

    ... for VA health care services and are experiencing homelessness. VA case managers may connect these Veterans with ... Veterans who have experienced long-term or repeated homelessness. As of Sept. 30, 2015, HUD had allocated ...

  11. Minority Veteran Report

    Data.gov (United States)

    Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

  12. Minority Veteran Report 2014

    Data.gov (United States)

    Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

  13. Paralyzed Veterans of America

    Science.gov (United States)

    ... Clothing Donate a Vehicle Matching Gifts Buy PVA Gear Donate Donate Now Give Monthly Planned Giving View ... PVA1946 National Veterans Wheelchair Games App Download Now TOP Contact Us Paralyzed Veterans of America 801 Eighteenth ...

  14. Master Veteran Index (MVI)

    Data.gov (United States)

    Department of Veterans Affairs — As of June 28, 2010, the Master Veteran Index (MVI) database based on the enhanced Master Patient Index (MPI) is the authoritative identity service within the VA,...

  15. Medical egg freezing: the importance of a patient-centered approach to fertility preservation.

    Science.gov (United States)

    Inhorn, Marcia C; Birenbaum-Carmeli, Daphna; Westphal, Lynn M; Doyle, Joseph; Gleicher, Norbert; Meirow, Dror; Raanani, Hila; Dirnfeld, Martha; Patrizio, Pasquale

    2017-11-09

    This binational qualitative study of medical egg freezing (MEF) examined women's motivations and experiences, including their perceived needs for patient-centered care in the midst of fertility- and life-threatening diagnoses. Forty-five women who had undertaken MEF were interviewed in the USA (33 women) and in Israel (12 women) between June 2014 and August 2016. Interviews lasted approximately 1 h and were conducted by two senior medical anthropologists, one in each country. Women were recruited from four American IVF clinics (two academic, two private) and two Israeli clinics (both academic) where MEF is being offered to cancer patients and women with other fertility-threatening medical conditions. Women who undertake MEF view their fertility and future motherhood as important components of their identities and recovery and, thus, are grateful for the opportunity to pursue fertility preservation. However, women who undergo MEF have special needs, given that they tend to be a "vulnerable" population of young (age < 30), unmarried, resource-constrained women, who are facing not only fertility loss but also the "double jeopardy" of cancer. Through in-depth, qualitative interviews, these women's MEF stories reveal 10 dimensions of care important to fertility preservation, including five "system factors" (information, coordination and integration, accessibility, physical comfort, cost) and five "human factors" (adolescent issues, male partner involvement, family involvement, egg disposition decisions, emotional support). Together, these dimensions of care constitute an important framework that can be best described as "patient-centered MEF." Women pursuing MEF have special medical needs and concerns, which require particular forms of patient-centered care. This study outlines 10 dimensions of patient-centered fertility preservation that are appropriate for MEF patients. This approach may help IVF clinics to be better prepared for delivering top-quality care to

  16. Is exposure to Agent Orange a risk factor for hepatocellular cancer?-A single-center retrospective study in the U.S. veteran population.

    Science.gov (United States)

    Krishnamurthy, Padmini; Hazratjee, Nyla; Opris, Dan; Agrawal, Sangeeta; Markert, Ronald

    2016-06-01

    Approximately 15% to 35% of those with chronic hepatitis C (CHC) related cirrhosis will develop hepatocellular cancer (HCC). With this burden increasing across the globe, identification of risk factors for HCC has become imperative. Exposure to Agent Orange has been implicated as a possible risk factor for liver cancer in a study from the Republic of Korea. However, there has been no study in U.S. veterans with CHC and cirrhosis that has evaluated exposure to Agent Orange as a risk factor for HCC. We conducted a retrospective study of U.S. military veterans diagnosed with CHC and cirrhosis over a period of 14 years to evaluate potential risk factors for HCC including exposure to Agent Orange. We retrospectively reviewed 390 patients with confirmed CHC-related cirrhosis between 2000 and 2013 and identified patients with HCC. We compared demographic, laboratory, and other clinical characteristics of patients with and without HCC. The mean age of the cohort was 51 years (SD =7.5), with the majority being male (98.5%). Seventy-nine of 390 (20.2%) patients developed HCC, diagnosed on average 8 (SD =4.8) years after diagnosis of CHC. Nearly half (49.4%) were Childs A, 40.5% were Childs B, and 10.1% were Childs C. HCC patients were more likely to be African American than non-HCC patients (40.5% vs. 25.4%, P=0.009) and to be addicted to alcohol (86.1% vs. 74.3%, P=0.027). A trend toward significance was seen in the HCC group for exposure to Agent Orange (16.5% vs. 10.0%, P=0.10) and smoking addiction (88.6% vs. 80.7%, P=0.10). Consequently, race, alcohol addiction, Agent Orange exposure, and smoking addiction were included in the multivariable logistic regression (MLR) analysis. Alcohol addiction [odds ratio (OR) =2.17; 95% confidence interval (CI), 1.07-4.43] and African American race (OR =2.07; 95% CI, 1.22-3.51) were found to be the only two definitive independent risk factors for HCC in our sample. African American race and alcohol addiction were independent risk

  17. Implementation and evaluation of carousel dispensing technology in a university medical center pharmacy.

    Science.gov (United States)

    Temple, Jack; Ludwig, Brad

    2010-05-15

    The implementation of carousel dispensing technology (CDT) at a university medical center pharmacy and the associated changes in drug distribution are described. An evaluation of CDT was conducted in three phases: before implementation, during implementation, and after implementation. The preimplementation phase consisted of data collection and facility planning leading up to the physical installation. The implementation phase included the physical installation, carousel medication assignment, and user training. The postimplementation phase included data collection and analysis. The data collected were used to compare preimplementation and postimplementation time studies, labor requirements, inventory turns, and accuracy rates. The estimated labor savings comparing the preimplementation and postimplementation time studies for automated dispensing cabinet (ADC) refills, first-dose requests, supplemental cart fill, and medication procurement totaled 2.6 full-time equivalents (FTEs). After departmental reorganization, a net reduction of 2.0 technician FTEs was achieved. The average turnaround time for stat medication requests using CDT was 7.19 minutes, and the percentage of doses filled in less than 20 minutes was 95.1%. After implementing CDT, the average accuracy rate for all dispense requests increased from 99.02% to 99.48%. The inventory carrying cost was reduced by $25,059. CDT improved the overall efficiency and accuracy of medication dispensing in a university medical center pharmacy. Workflow efficiencies achieved in ADC refill, first-dose dispensing, supplemental cart fill, and the medication procurement process allowed the department to reduce the amount of technician labor required to support the medication distribution process, as well as reallocate technician labor to other areas in need.

  18. Home medication support for childhood cancer: family-centered design and testing.

    Science.gov (United States)

    Walsh, Kathleen E; Biggins, Colleen; Blasko, Deb; Christiansen, Steven M; Fischer, Shira H; Keuker, Christopher; Klugman, Robert; Mazor, Kathleen M

    2014-11-01

    Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study. Copyright © 2014 by American Society of Clinical Oncology.

  19. Diseases pattern among patients attending Holy Mosque (Haram) Medical Centers during Hajj 1434 (2013)

    Science.gov (United States)

    Bakhsh, Abdulrahman R.; Sindy, Abdulfattah I.; Baljoon, Mostafa J.; Dhafar, Khalid O.; Gazzaz, Zohair J.; Baig, Mukhtiar; Deiab, Basma A.; Hothali, Fauzea T. Al

    2015-01-01

    Objective: To evaluate the diseases pattern among pilgrims attending the 2 Holy Mosque (Haram) Health Care Centers during the Hajj season 2013 (Hijra 1434). Methods: In this cross-sectional study, data was collected from 2 medical centers located in the Holy Mosque in Makkah city, Saudi Arabia, from the first of Dhul-Hijjah to sixteenth Dhul-Hijjah 1434. The present study was completed in 16 days (6th October to 21st October 2013). Results: Over 16 days, 1008 patients attended the medical centers during Hajj 1434, (2013), out of which 554 (55%) were males and 454 (45%) were females. Most of the patients were Egyptians (n=242, 24%), followed by Saudis (n=116, 11.5%), Pakistani (n=114, 11.3%), Turkish (n=50, 5%), and other nationalities (n=404). According to age distribution, mostly were in the 51-60 years age group (n=237, 23.5%), followed by other age groups. Out of 1008 patients, 842 (83.5%) patients were treated and subsequently discharged, while 166 patients (16.5%) were referred to the tertiary centers. According to the diseases pattern, most of the patients were suffering from respiratory problems (n=177, 17.6%) followed by skin diseases (n=158, 15.7%), gastrointestinal tract (GIT) diseases (n=133, 13.2%), and others. Conclusion: Most of the patients were suffering from respiratory problems followed by skin and GIT diseases, and <25% of patients were referred to tertiary care centers. PMID:26219447

  20. Expediting Time from Symptoms to Medical Contact Utilizing a Telemedicine Call Center.

    Science.gov (United States)

    Leshem-Rubinow, Eran; Assa, Eyal Ben; Shacham, Yacov; Zatelman, Avivit; Oren-Shamir, Ayelet; Malov, Nomi; Golovner, Michal; Roth, Arie

    2015-10-01

    No definitive solution has been forthcoming for the often dangerously long interval between symptom onset and seeking medical care in the prehospital setting. We examined the implementation of telemedicine technology and characterization of its utilizers for its efficacy in reducing this possibly life-threatening time lag. A retrospective observational study was performed on the working database of an operational telemedicine facility that included all subscribers. Time-to-contact measurements throughout 2012 were retrieved from its medical files, and data on age, gender, medical history, and main complaint were analyzed. Throughout 2012, 22,274 of a total of 46,556 calls (47.8%) were made ≤60 min from symptom onset. It is important that 26.9% of all calls (12,522/46,556) were made in 60 years (19,386/40,839 [47%], p<0.001). Patients with prior resuscitation and/or myocardial infarction contacted significantly more rapidly than those with other cardiac diseases. Over one-half of patients with cardiac complaints contacted the call center ≤60 min from symptom onset, as did those who suffered physical trauma, but not patients with gastrointestinal symptoms or pain elsewhere. A telemedicine system with rapid accessibility to a professional call center and prompt triage thereafter could be an additional promising strategy for shortening the interval between symptom onset and call for medical assistance. Implementation of a widespread telemedicine infrastructure may bridge the unmet gap between occurrence of symptoms to initiation of medical treatment.

  1. [E-learning in ENT: Usage in University Medical Centers in Germany].

    Science.gov (United States)

    Freiherr von Saß, Peter; Klenzner, Thomas; Scheckenbach, Kathrin; Chaker, Adam

    2017-03-01

    E-learning is an essential part of innovative medical teaching concepts. The challenging anatomy and physiology in ENT is considered particularly suitable for self-assessed and adaptive e-learning. Usage and data on daily experience with e-learning in German ENT-university hospitals are currently unavailable and the degree of implementation of blended learning including feed-back from medical students are currently not known. We investigated the current need and usage of e-learning in academic ENT medical centers in Germany. We surveyed students and chairs for Otorhinolaryngology electronically and paperbased during the summer semester 2015. Our investigation revealed an overall heterogenous picture on quality and quantity of offered e-learning applications. While the overall amount of e-learning in academic ENT in Germany is rather low, at least half of the ENT-hospitals in medical faculties reported that e-learning had improved their own teaching activities. More collaboration among medical faculties and academic ENT-centers may help to explore new potentials, overcome technical difficulties and help to realize more ambitious projects. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Development of a longitudinal integrated clerkship at an academic medical center.

    Science.gov (United States)

    Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia

    2011-04-04

    In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

  3. United States academic medical centers: priorities and challenges amid market transformation.

    Science.gov (United States)

    Thompson, Irene M; Anason, Barbara

    2012-01-01

    United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation.

  4. Development of a longitudinal integrated clerkship at an academic medical center

    Directory of Open Access Journals (Sweden)

    Ann Poncelet

    2011-04-01

    Full Text Available In 2005, medical educators at the University of California, San Francisco (UCSF, began developing the Parnassus Integrated Student Clinical Experiences (PISCES program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants’ career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

  5. Discharge against medical advice in a pediatric emergency center in the State of Qatar

    Directory of Open Access Journals (Sweden)

    Hala Abdulateef

    2012-05-01

    Full Text Available Objective: The objective of this study was to analyze cases that had left the Pediatric Emergency Center Al Sadd, Doha (PEC against medical advice, with the aim of developing policies to help reduce this occurrence. Methodology: All patients that were admitted to the main PEC observation room for treatment and/or investigation and subsequently left against medical advice from February 18, 2007 to June 18, 2007, were followed by a phone call, and a questionnaire, which was completed by the departmental patient representative. Results: 99,133 patients attended the facility during the study period. Of those, 106 left the facility against medical advice. Ninety-four guardians were successfully contacted. 90% of the cases were in children below 2 years of age. In 87% of the cases the mother was the main decision maker for leaving against medical advice. Domestic obligations were the leading cause of DAMA (discharge against medical advice, reported in 45% of the cases. Respondents reported that the consequences of DAMA were well explained by medical staff before they left the facility however, they had not met with the departmental patient representative during their stay. Conclusion:As the majority of DAMA cases occurred in infants, medical staff should address the concerns of this group early on in the course of treatment. Maintaining communication and providing support, in particular for mothers of higher risk groups may help to reduce the rate of DAMA cases.

  6. Medical diplomacy and global mental health: from community and national institutions to regional centers of excellence.

    Science.gov (United States)

    Aggarwal, Neil Krishan; Kohrt, Brandon A

    2013-12-01

    We explore how regional medical diplomacy can increase funding for global mental health initiatives. Interventions for infectious diseases have dominated medical diplomacy by focusing on security concerns. The global mental health movement has adopted similar strategies, but unsuccessfully since mental illnesses do not cause international epidemics. Instead, realpolitik arguments may increase funding by prioritizing economic productivity and regional diplomacy based on cultural ties to advance mental health services and research at the community level. In South Asia, initiatives to train personnel and provide refugee services offer a foundation for regional centers of excellence. This model can be expanded elsewhere.

  7. The Tripler Army Medical Center LEAN Program: a healthy lifestyle model for the treatment of obesity.

    Science.gov (United States)

    James, L C; Folen, R A; Garland, F N; Edwards, C; Noce, M; Gohdes, D; Williams, D; Bowles, S; Kellar, M A; Supplee, E

    1997-05-01

    This paper provides an overview of the Tripler Army Medical Center LEAN Program for the treatment of obesity, hypercholesterolemia, and essential hypertension. The LEAN Program, a multi-disciplinary prevention program, emphasizes healthy Lifestyles, Exercise and Emotions, Attitudes, and Nutrition for active duty service members. The treatment model offers a medically healthy, emotionally safe, and reasonable, low-intensity exercise program to facilitate weight loss. We will discuss the philosophy behind the LEAN Program and the major components. Thereafter, we will briefly discuss the preliminary results.

  8. A new concept for medical imaging centered on cellular phone technology.

    Science.gov (United States)

    Granot, Yair; Ivorra, Antoni; Rubinsky, Boris

    2008-04-30

    According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a) a data acquisition device (DAD) at a remote patient site that is simple, with limited controls and no image display capability and b) an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site). The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

  9. A new concept for medical imaging centered on cellular phone technology.

    Directory of Open Access Journals (Sweden)

    Yair Granot

    2008-04-01

    Full Text Available According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a a data acquisition device (DAD at a remote patient site that is simple, with limited controls and no image display capability and b an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site. The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

  10. Important aspects of end-of-life care among veterans: implications for measurement and quality improvement.

    Science.gov (United States)

    Casarett, David; Pickard, Amy; Amos Bailey, F; Ritchie, Christine; Furman, Christian; Rosenfeld, Ken; Shreve, Scott; Shea, Judy A

    2008-02-01

    To identify aspects of end-of-life care in the U.S. Department of Veterans Affairs (VA) health care system that are not assessed by existing survey instruments and to identify issues that may be unique to veterans, telephone interviews using open-ended questions were conducted with family members of veterans who had received care from a VA facility in the last month of life. Responses were compared to validated end-of-life care assessment instruments in common use. The study took place in four VA medical centers and one family member per patient was invited to participate, selected from medical records using predefined eligibility criteria. These family members were asked to describe positive and negative aspects of the care the veteran received in the last month of life. Interview questions elicited perceptions of care both at VA sites and at non-VA sites. Family reports were coded and compared with items in five existing prospective and retrospective instruments that assess the quality of care that patients receive near the end of life. Interviews were completed with 66 family members and revealed 384 codes describing both positive and negative aspects of care during the last month of life. Almost half of these codes were not represented in any of the five reference instruments (n=174; 45%). These codes, some of which are unique to the veteran population, were grouped into eight categories: information about VA benefits (n=36; 55%), inpatient care (n=36; 55%), access to care (n=33; 50%), transitions in care (n=32; 48%), care that the veteran received at the time of death (n=31; 47%), home care (n=26; 40%), health care facilities (n=12; 18%), and mistakes and complications (n=18; 27%). Although most of the reference instruments assessed some aspect of these categories, they did not fully capture the experiences described by our respondents. These data suggest that many aspects of veterans' end-of-life care that are important to their families are not assessed by

  11. Prevalence of probable mental disorders and help-seeking behaviors among veteran and non-veteran community college students.

    Science.gov (United States)

    Fortney, John C; Curran, Geoffrey M; Hunt, Justin B; Cheney, Ann M; Lu, Liya; Valenstein, Marcia; Eisenberg, Daniel

    2016-01-01

    Millions of disadvantaged youth and returning veterans are enrolled in community colleges. Our objective was to determine the prevalence of mental disorders and help-seeking behaviors among community college students. Veterans (n=211) and non-veterans (n=554) were recruited from 11 community colleges and administered screeners for depression (PHQ-9), generalized anxiety (GAD-7), posttraumatic stress disorder (PC-PTSD), non-lethal self-injury, suicide ideation and suicide intent. The survey also asked about the perceived need for, barriers to and utilization of services. Regression analysis was used to compare prevalence between non-veterans and veterans adjusting for non-modifiable factors (age, gender and race/ethnicity). A large proportion of student veterans and non-veterans screened positive and unadjusted bivariate comparisons indicated that student veterans had a significantly higher prevalence of positive depression screens (33.1% versus 19.5%, Pdepression (OR=2.10, P=.01) and suicide ideation (OR=2.31, P=.03). Student veterans had significantly higher odds of perceiving a need for treatment than non-veterans (OR=1.93, P=.02) but were more likely to perceive stigma (beta=0.28, P=.02). Despite greater need among veterans, there were no significant differences between veterans and non-veterans in use of psychotropic medications, although veterans were more likely to receive psychotherapy (OR=2.35, P=.046). Findings highlight the substantial gap between the prevalence of probable mental health disorders and treatment seeking among community college students. Interventions are needed to link community college students to services, especially for student veterans. Copyright © 2016. Published by Elsevier Inc.

  12. Implementation of a Routine Health Literacy Assessment at an Academic Medical Center.

    Science.gov (United States)

    Warring, Carrie D; Pinkney, Jacqueline R; Delvo-Favre, Elaine D; Rener, Michelle Robinson; Lyon, Jennifer A; Jax, Betty; Alexaitis, Irene; Cassel, Kari; Ealy, Kacy; Hagen, Melanie Gross; Wright, Erin M; Chang, Myron; Radhakrishnan, Nila S; Leverence, Robert R

    2017-11-14

    Limited health literacy is a common but often unrecognized problem associated with poor health outcomes. Well-validated screening tools are available to identify and provide the opportunity to intervene for at-risk patients in a resource-efficient manner. This is a multimethod study describing the implementation of a hospital-wide routine health literacy assessment at an academic medical center initiated by nurses in April 2014 and applied to all adult inpatients. Results were documented in the electronic health record, which then generated care plans and alerts for patients who screened positive. A nursing survey showed good ease of use and adequate patient acceptance of the screening process. Six months after hospital-wide implementation, retrospective chart abstraction of 1,455 patients showed that 84% were screened. We conclude that a routine health literacy assessment can be feasibly and successfully implemented into the nursing workflow and electronic health record of a major academic medical center.

  13. Patient-centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis

    Science.gov (United States)

    Conn, Vicki S.; Ruppar, Todd M.; Enriquez, Maithe; Cooper, Pamela S.

    2016-01-01

    Objectives This systematic review used meta-analytic procedures to synthesize changes in patient-centered outcomes following medication adherence interventions. Methods Strategies to locate studies included online searches of 13 databases and 19 research registries, hand searches of 57 journals, and author and ancestry searches of all eligible studies. Search terms included patient compliance, medication adherence, and related terms. Searches were conducted for all studies published since 1960. Eligible published or unpublished primary studies tested medication adherence interventions and reported medication knowledge, quality of life, physical function, and symptom outcomes. Primary study attributes and outcome data were reliably coded. Overall standardized mean differences (SMDs) were analyzed using random-effects models. Dichotomous and continuous moderator analyses and funnel plots were used to explore risks of bias. Results Thorough searching located eligible 141 reports. The reports included 176 eligible comparisons between treatment and control subjects across 23,318 subjects. Synthesis across all comparisons yielded statistically significant SMDs for medication knowledge (d = 0.449), quality of life (d = 0.127), physical function (d = 0.142), and symptoms (d = 0.182). The overall SMDs for studies focusing on subsamples of patients with specific illnesses were more modest but also statistically significant. Of specific symptoms analyzed (depression, anxiety, pain, energy/vitality, cardiovascular, and respiratory), only anxiety failed to show a significant improvement following medication adherence interventions. Most SMDs were significantly heterogeneous, and risk of bias analyses suggested links between study quality and SMDs. Conclusions Modest but significant improvements in patient-centered outcomes followed medication adherence interventions. PMID:27021763

  14. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program.

    Science.gov (United States)

    Duong, David B; Sullivan, Erin E; Minter-Jordan, Myechia; Giesen, Lindsay; Ellner, Andrew L

    2016-01-01

    In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers. The AoC is modeled in the form of a 'grants challenge', offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation. Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program. Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

  15. Technology complementing military behavioral health efforts at tripler army medical center.

    Science.gov (United States)

    Stetz, Melba C; Folen, Raymond A; Yamanuha, Bronson K

    2011-06-01

    The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.

  16. Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned.

    Science.gov (United States)

    Budgen, Jacqueline; Cantiello, John

    This article provides a detailed examination of the pros and cons associated with patient-centered medical homes (PCMHs). Opinions and findings from those who have studied PCMHs and those who have been directly involved with this type of health care model are outlined. Key lessons from providers are detailed, and critical success factors are highlighted. This synthesized analysis serves to lend evidence to health care managers and providers who are considering implementation of the PCMH model.

  17. Merging Systems: Integrating Home Visitation and the Family-Centered Medical Home

    OpenAIRE

    Tschudy, Megan M.; Toomey, Sara L.; Cheng, Tina L.

    2013-01-01

    To improve the health of children and bend the health care cost curve we must integrate the individual and population approaches to health and health care delivery. The 2012 Institute of Medicine (IOM) report Primary Care and Public Health: Exploring Integration to Improve Population Health laid out the continuum for integration of primary care and public health stretching from isolation to merging systems. Integration of the family-centered medical home (FCMH) and home visitation (HV) would ...

  18. Institution of a Rubella Screening and Immunization Program at Tripler Army Medical Center

    Science.gov (United States)

    1979-06-01

    to accomplish the same goal of protecting the best interest of mother , child and Tripler Army Medical Center. 59 HST-CPOH (26 Oct 78) SUBJECT: TAC...person who is infected doughs , sneezes or speaks. Symptoms of the disease are characterized by a mild upper respiratory illness with a low fever and a...children being born with congenital birth defects to mothers inadvertently exposed to rubella virus during pregnancy. 3. The health records of

  19. Acquisition: Controls Over Purchase Cards at Naval Medical Center San Diego

    Science.gov (United States)

    2004-06-29

    convenience check, shop at the wholesale membership club to identify merchandise and costs, travel to the medical center for the check, and return to the...wholesale membership club to pay for the merchandise and complete the purchase transaction. Shopping at membership warehouses, which do not accept...amount of $207.21 on November 19, 2002, was a Clinical Investigation Department purchase from a supermarket . The purchase was for bottled water, a

  20. Designing Information Systems in Health Services Administration Medical Center Pamulang Permai II Tangerang.

    OpenAIRE

    Diana Meivita

    2005-01-01

    In writing this thesis discussed the design of Information Systems in Health Care Administration Medical Center Pamulang Permai II, Tangerang, where the administrative system that done at this clinic was using manual systems. So it required the design of administrative information systems in order to help alleviate and accelerate the work process, but it can streamline the data processing time. The first author analyzes a system running on these clinics, then the author tries to make the desi...

  1. Visual screening of oral cavity cancer in a male population: Experience from a medical center

    OpenAIRE

    Chang, I-How; Jiang, Rong-San; Wong, Yong-Kie; Wu, Shang-Heng; Chen, Fun-Jou; Liu, Shih-An

    2011-01-01

    Background: We aimed to evaluate the effectiveness of an oral cavity cancer visual screening program conducted in a tertiary academic medical center. We also wanted to determine which group of participants was at greater risk of contracting oral cavity cancer. Methods: Participants were first asked to relate their personal habits during the past 6 months. Visual screening of the oral cavity was then performed under adequate lighting and with proper instruments. Results: From March 2005 ...

  2. Comparison of patient outcomes in academic medical centers with and without value analysis programs

    Directory of Open Access Journals (Sweden)

    Murray AS

    2012-09-01

    Full Text Available Adrienne S Murray, Michael Griswold, Imran Sunesara, Ed SmithUniversity of Mississippi Health Care, University of Mississippi Medical Center, Jackson, MS, USABackground: Value analysis is the science of balancing the mandate to deliver high-quality clinical outcomes with the necessity to drive down costs in order to thrive in the challenging economics of health care. This study compared average length of stay, direct cost, morbidity, and mortality across the cardiology, cardiovascular, neuroscience, and orthopedic service lines, in academic medical centers with and without value analysis programs (VAPs. The basic question was, “Do academic medical centers with VAPs have lower average length of stay, better morbidity and mortality rates, and lower overall supply costs?”Methods and results: The clinical data base/resource manager (CDB/RM of the University HealthSystem Consortium was utilized as secondary data for this study. Reports from the CDB/RM were generated from 2006 to 2011. Continuous variable differences across VAP status were examined using Wilcoxon two-sample tests. Primary analyses used multilevel linear mixed model methods to estimate the effects of VAPs on primary outcomes (average length of stay, cost, morbidity, mortality. Association components of the linear mixed models incorporated random effects at the hospital level and robust, Huber-White, standard errors were calculated. There was no significant difference for average length of stay, direct cost, morbidity, and mortality between academic medical centers with and without VAPs. However, outcomes were not noted to be substantially worse.Conclusion: Numerous case studies reveal that aggressively active VAPs do decrease hospital cost. Also, this study did not find a negative impact on patient care. Further studies are needed to explore the benefits of value analysis and its effect on patient outcomes.Keywords: value analysis, average length of stay, morbidity, mortality

  3. Training Tomorrow's Doctors: The Medical Education Mission of Academic Health Centers. A Report of the Commonwealth Fund Task Force on Academic Health Centers.

    Science.gov (United States)

    Commonwealth Fund, New York, NY.

    This report, fifth of a series on Academic Health Centers (AHCs), addresses the fundamental rationale of such centers: the education of the health care workforce. None of the missions of the 125 AHCs in the United States, medical schools and their closely affiliated hospitals and physician groups, is more important than the education of…

  4. A Comparison of Collaborative Care Outcomes in Two Health Care Systems: VA Clinics and Federally Qualified Health Centers.

    Science.gov (United States)

    Grubbs, Kathleen M; Fortney, John C; Pyne, Jeffrey; Mittal, Dinesh; Ray, John; Hudson, Teresa J

    2018-01-16

    Collaborative care for depression results in symptom reduction when compared with usual care. No studies have systematically compared collaborative care outcomes between veterans treated at Veterans Affairs (VA) clinics and civilians treated at publicly funded federally qualified health centers (FQHCs) after controlling for demographic and clinical characteristics. Data from two randomized controlled trials that used a similar collaborative care intervention for depression were combined to conduct post hoc analyses (N=759). The Telemedicine-Enhanced Antidepressant Management intervention was delivered in VA community-based outpatient clinics (CBOCs), and the Outreach Using Telemedicine for Rural Enhanced Access in Community Health intervention was delivered in FQHCs. Multivariate logistic regression was used to determine whether veteran status moderated the effect of the intervention on treatment response (>50% reduction in symptoms). There was a significant main effect for intervention (odds ratio [OR]=5.23, p<.001) and a moderating effect for veteran status, with lower response rates among veterans compared with civilians (OR=.21, p=.01). The addition of variables representing medication dosage and number of mental health and general health appointments did not influence the moderating effect. A sensitivity analysis stratified by gender found a significant moderating effect of veteran status for men but not women. Veteran status was a significant moderator of collaborative care effectiveness for depression, indicating that veterans receiving collaborative care at a CBOC are at risk of nonresponse. Unmeasured patient- or system-level characteristics may contribute to poorer response among veterans.

  5. Characteristics of postgraduate year 1 pharmacy residency programs at academic medical centers.

    Science.gov (United States)

    Phillips, Holly; Jasiak, Karalea D; Lindberg, Lance S; Ryzner, Kristi L

    2011-08-01

    The training components and other characteristics of postgraduate year 1 (PGY1) pharmacy residency programs at a sample of academic medical centers were evaluated. A questionnaire was sent via e-mail to the directors of 98 PGY1 residency programs at academic medical centers in the University HealthSystem Consortium (UHC) to elicit benchmarking data on issues such as recruitment, learning experiences, resident staffing requirements, resident research projects and professional presentations, opportunities for resident participation in teaching activities, and requirements for faculty service as preceptors; 72 program directors responded to the survey. The residency programs represented in the survey reported an average of approximately 14 applicants for each available position in 2010 and an average of about five candidate interviews per available position. The survey results indicated wide variation in the learning experiences offered by PGY1 programs (the most commonly reported rotations were in administration, critical care, internal medicine, ambulatory care, and drug information), with a high degree of individualization of elective rotations. Almost all programs had a mandatory staffing component, typically requiring 4-10 hours of service weekly. Results of this survey indicate that there is a large amount of variation in the components of PGY1 pharmacy residency programs among UHC academic medical centers. The majority of respondents reported no change in the number of residency positions offered within the past two years, but they reported an increase in the number of applications from 2009 to 2010.

  6. Implementing lifestyle medicine with medication therapy management services to improve patient-centered health care.

    Science.gov (United States)

    Lenz, Thomas L; Monaghan, Michael S

    2011-01-01

    To describe a patient-centered medication therapy management (MTM) program that focuses on lifestyle medicine. Community pharmacy in Omaha, NE, from August 2008 to September 2010. Traditional MTM services are combined with lifestyle medicine interventions for employees of a self-insured organization who have dyslipidemia, hypertension, and/or diabetes. Program participants meet one-on-one with a pharmacist 12 times during the first year of the program to ensure proper drug therapy and modify lifestyle behaviors (physical activity, nutrition, weight control, sleep, stress, and alcohol and tobacco use) through individualized programming. Several patient-centered activities have been developed for the program with an emphasis on modifying lifestyle behaviors in conjunction with medications to manage participants' chronic condition. In addition, a new specialty position in health care is being developed (the ambulatist) that focuses on maintaining the ambulatory status of individuals with chronic medical conditions through appropriate drug therapy, lifestyle medicine, and care coordination. Biometric data collection and participant survey data at baseline and after 12 months. Pilot data for 15 participants showed improvements in all measurements, including blood cholesterol, low-density lipoprotein cholesterol, blood glucose, body weight, physical activity level, fruit and vegetable intake, risk for myocardial infarction, risk for any cardiovascular disease event, self-reported unhealthy days, and qualitative survey data. Pharmacists are in an ideal position to implement lifestyle medicine strategies in combination with MTM services to enhance patient-centered health care in a community pharmacy setting.

  7. Analysis of 10-Year Training Results of Medical Students Using the Microvascular Research Center Training Program.

    Science.gov (United States)

    Onoda, Satoshi; Kimata, Yoshihiro; Sugiyama, Narushi; Tokuyama, Eijiro; Matsumoto, Kumiko; Ota, Tomoyuki; Thuzar, Moe

    2016-06-01

    Background In this article, we reviewed the training results of medical students using the Microvascular Research Center Training Program (MRCP), and proposed an ideal microsurgical training program for all individuals by analyzing the training results of medical students who did not have any surgical experience. Methods As of 2015, a total of 29 medical students completed the MRCP. In the most recent 12 medical students, the number of trials performed for each training stage and the number of rats needed to complete the training were recorded. Additionally, we measured the operating time upon finishing stage 5 for the recent six medical students after it became a current program. Results The average operating time upon finishing stage 5 for the recent six medical students was 120 minutes ± 11 minutes (standard deviation [SD]). The average vascular anastomosis time (for the artery and vein) was 52 minutes ± 2 minutes (SD). For the most recent 12 medical students, there was a negative correlation between the number of trials performed in the non-rat stages (stages 1-3) and the number of rats used in the rat stages (stages 4-5). Conclusion Analysis of the training results of medical students suggests that performing microsurgery first on silicon tubes and chicken wings saves animals' lives later during the training program. We believe that any person can learn the technique of microsurgery by performing 7 to 8 hours of training per day over a period of 15 days within this program setting. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Prescribing pharmacists in the ambulatory care setting: Experience at the University of North Carolina Medical Center.

    Science.gov (United States)

    Hawes, Emily M; Misita, Caron; Burkhart, Jena Ivey; McKnight, Lauren; Deyo, Zachariah M; Lee, Ruth-Ann; Howard, Caroline; Eckel, Stephen F

    2016-09-15

    The prescribing authorities, clinical activities, and productivity documentation strategies of ambulatory care clinic-based pharmacists practicing within a large academic health system are described. North Carolina law encourages progressive pharmacy practice through acquisition of the clinical pharmacist practitioner (CPP) designation. Qualified CPPs are authorized to provide collaborative drug therapy management services, including medication prescribing and ordering of laboratory tests, according to defined protocols and under physician supervision. The University of North Carolina Medical Center has approximately 30 CPPs deployed across a wide range of ambulatory care clinical practice sites. This article describes (1) the pharmacy department's implementation of an ambulatory care practice model, (2) the credentialing and privileging process leading to granting of prescribing privileges, (3) metrics used to demonstrate the impact of CPP activities, (4) recommended general criteria for ambulatory care practice site identification, and (5) strategies for overcoming barriers to successful implementation of ambulatory care-focused clinical pharmacist services. Aggregated intervention-tracking data compiled by seven of the medical center's CPP ambulatory care practice sites indicate extensive CPP involvement in direct patient care encounters and patient or provider consultations, with large numbers of medication-related interventions to support institutional cost-avoidance and revenue goals. CPPs deployed at the medical center's ambulatory care clinics have had a positive impact on clinical and cost outcomes, improving patient care through interventions, contributing to readmission reduction efforts, generating indirect revenue through cost avoidance, and generating new revenue through billing for patient visits. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  9. Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives.

    Science.gov (United States)

    Singh, Jasvinder A; Herbey, Ivan; Bharat, Aseem; Dinnella, Janet E; Pullman-Mooar, Sally; Eisen, Seth; Ivankova, Nataliya

    2017-11-01

    To explore gout self-management and associated challenges and solutions in African Americans. We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support. Thirty-five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m 2 , 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources. Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout. © 2017, American College of Rheumatology.

  10. Strom Thurmond Biomedical Research Center at the Medical Univesity for South Carolina Charleston, South Carolina

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    The Department of Energy (DOE) has prepared an Environmental Assessment (EA) evaluating the proposed construction and operation of the Strom Thurmond Biomedical Research Center (Center) at the Medical University of South Carolina (MUSC), Charleston, SC. The DOE is evaluating a grant proposal to authorize the MUSC to construct, equip and operate the lower two floors of the proposed nine-story Center as an expansion of on-going clinical research and out-patient diagnostic activities of the Cardiology Division of the existing Gazes Cardiac Research Institute. Based on the analysis in the EA, the DOE has determined that the proposed action does not constitute a major federal action significantly affecting the quality of the human environment within the meaning of the NEPA. Therefore, the preparation of an Environmental Impact Statement is not required.

  11. Six ways problem-based learning cases can sabotage patient-centered medical education.

    Science.gov (United States)

    MacLeod, Anna

    2011-07-01

    Problem-based learning (PBL) cases tell a story of a medical encounter; however, the version of the story is typically very biomedical in focus. The patient and her or his experience of the situation are rarely the focus of the case despite a prevalent discourse of patient-centeredness in contemporary medical education. This report describes a qualitative study that explored the question, "How does PBL teach medical students about what matters in medicine?" The qualitative study, culminating in 2008, involved three data collection strategies: (1) a discourse analysis of a set of PBL cases from 2005 to 2006, (2) observation of a PBL tutorial group, and (3) semistructured, in-depth, open-ended interviews with medical educators and medical students. In this report, using data gathered from 67 PBL cases, 26 hours of observation, and 14 interviews, the author describes six specific ways in which PBL cases-if not thoughtfully conceptualized and authored-can serve to overlook social considerations, thereby undermining a patient-centered approach. These comprise the detective case, the shape-shifting patient, the voiceless PBL person, the joke name, the disembodied PBL person, and the stereotypical PBL person. PBL cases constitute an important component of undergraduate medical education. Thoughtful authoring of PBL cases has the potential to reinforce, rather than undermine, principles of patient-centeredness.

  12. Psychology in patient-centered medical homes: Reducing health disparities and promoting health equity.

    Science.gov (United States)

    Farber, Eugene W; Ali, Mana K; Van Sickle, Kristi S; Kaslow, Nadine J

    2017-01-01

    With persisting health disparities contributing to a disproportionate impact on the health and well-being of socially disenfranchised and medically underserved populations, the emerging patient-centered medical home (PCMH) model offers promise in bridging the health disparities divide. Because behavioral health care is an important component of the PCMH, psychologists have significant opportunity to contribute to the development and implementation of PCMH services in settings that primarily serve medically underserved communities. In this article, after briefly defining the PCMH model and its role in clinical settings for medically underserved populations for whom health disparities are present, roles of psychologists as interprofessional collaborators on PCMH medical care teams are explored. Next, the constellation of competencies that position psychologists as behavioral health specialists to contribute to PCMH care teams for medically underserved groups are characterized. The article concludes with reflections on the prospects for psychologists to make tangible contributions as health care team members toward reducing health disparities and promoting health equity in patients served in the PCMH. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Clinical significance of Blastocystis hominis: experience from a medical center in northern Taiwan.

    Science.gov (United States)

    Kuo, Han-Yueh; Chiang, Dung-Hung; Wang, Chien-Chun; Chen, Te-Li; Fung, Chang-Phone; Lin, Chih-Pei; Cho, Wen-Long; Liu, Cheng-Yi

    2008-06-01

    Blastocystis hominis is an intestinal protozoan. The pathogenic role of this organism in human beings is still controversial and has varied among reports from different geographic areas. The purpose of this study was to determine the clinical significance of B. hominis in northern Taiwan. A total of 100 patients who had a positive B. hominis stool examination during the period April to December of 2001 were retrospectively identified from Taipei Veterans General Hospital. The demographic and clinical characteristics of these patients were reviewed from the medical records. All of the patients were adults. Fifty nine patients had more than one underlying diseases, including malignancies. Twenty one patients presented with fever and 10 patients had gastrointestinal symptoms, including diarrhea and/or abdominal pain. However, all of the patients had other conditions that might have contributed to the clinical presentation, and they improved without specific treatment for B. hominis. Furthermore, there were no significant differences in clinical symptoms and white blood cell count between patients with malignancy or diabetes mellitus and those without. Six patients had hypereosinophilia that could not be attributed to other causes. Among 34 patients who had a further stool examination within one year, B. hominis was undetectable in 31 patients (91.2%), despite their having no specific antiprotozoal treatment. The association of clinical symptoms and B. hominis could not be delineated from our study, even in immunocompromised patients. All of the patients improved without receiving any specific therapy. More studies from different areas are needed in order to delineate the clinical significance B. hominis.

  14. Incorporating the principles of the patient- centered medical home into a student-run free clinic

    Directory of Open Access Journals (Sweden)

    Riddle MC

    2014-09-01

    Full Text Available Megan C Riddle,1,* Jiahui Lin,3,* Jonathan B Steinman,2 Joshua D Salvi,2 Margaret M Reynolds,3 Anne S Kastor,3,† Christina Harris,4 Carla Boutin-Foster3 1Department of Psychiatry and Behavioral Sciences, University of Washington, 2Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program, 3Department of Internal Medicine, Weill Cornell Medical College, New York, NY, 4Department of Medicine, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, LA, USA *These authors contributed equally to this work †Anne S Kastor passed away on July 5, 2013. Abstract: As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC, a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87

  15. Key Elements of Clinical Physician Leadership at an Academic Medical Center

    Science.gov (United States)

    Dine, C. Jessica; Kahn, Jeremy M; Abella, Benjamin S; Asch, David A; Shea, Judy A

    2011-01-01

    Background A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training. Methods We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership. Results Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes. Conclusions Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training. PMID:22379520

  16. Key elements of clinical physician leadership at an academic medical center.

    Science.gov (United States)

    Dine, C Jessica; Kahn, Jeremy M; Abella, Benjamin S; Asch, David A; Shea, Judy A

    2011-03-01

    A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training. We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership. Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes. Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training.

  17. The Veterans Choice Program (VCP): Program Implementation

    Science.gov (United States)

    2017-01-05

    to VACAA and challenges encountered during implantation of the law. Table 1 provides major highlights pertaining to the Veterans Choice Program (VCP...outpatient medical, surgical, and mental healthcare; pharmaceuticals; pregnancy and delivery services; dental care; and durable medical equipment, and

  18. Research Battles: Survival Tips From a Veteran

    Science.gov (United States)

    Isaacs, Linda L.

    2015-01-01

    Studies of nonorthodox medical treatments may go awry because of inherent flaws in designs that are better suited for trials of pharmaceutical products. Unintended consequences may follow from efforts at randomization, the lack of lead-in periods, required visits for medical assessment, inadequate screening, and a lack of trial publicity. A veteran of a mismanaged trial shares her experiences. PMID:26770164

  19. Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

    Science.gov (United States)

    Levy, Cari; Whitfield, Emily A

    2016-12-01

    To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. Descriptive, unmatched study. VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs). Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011. Using VA and Medicare data from fiscal years 2010 and 2011, demographic characteristics, healthcare use, and costs of 388 veterans in MFHs were compared with 26,037 of those in HBPC, 5,355 in CLCs, and 5,517 in CNHs in the year before and the year after enrollment. Veterans enrolled in the MFH program were more likely to be unmarried than those in other LTC programs and had higher levels of comorbidity and frailty than veterans receiving HBPC but had similar levels of comorbidity, frailty, and healthcare use as those in CLCs and CNHs. MFH veterans incurred lower costs than those in CNHs and CLCs. MFHs served a distinct subset of veterans with levels of comorbidity and frailty similar to those of veterans cared for in CLCs and CNHs at costs that were comparable to or lower than those of the VHA. Propensity-matched comparisons will be necessary to confirm these findings. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  20. Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group.

    Science.gov (United States)

    Schumm, Jeremiah A; Walter, Kristen H; Bartone, Anne S; Chard, Kathleen M

    2015-06-01

    To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). Participants endorsed a significantly stronger preference for CPT versus other psychotherapies. PE was significantly preferred over nightmare resolution therapy and present-centered therapy, and both PE and cognitive-behavioral conjoint therapy were preferred over virtual reality exposure therapy. Results suggest that by informing consumers about evidence-based treatments for PTSD, pre-treatment educational approaches may increase consumer demand for these treatment options. Published by Elsevier Ltd.

  1. Creating and sustainable development of specialized centers as a way to improve quality of medical care

    Directory of Open Access Journals (Sweden)

    V. I. Guzeva

    2016-01-01

    Full Text Available Quality of care is evaluated on the completeness of the survey, the correct diagnosis, treatment efficacy, and its duration. Improving the quality and efficiency of medical care for children with paroxysmal disorders of consciousness is one of topical problems of neurology.Aim. The aim of the work is to justify the relationship between improving the quality of health care and sustainable development in the modern conditions of specialized medical centers on the example of the work on the identification and treatment of children with paroxysmal disorders of consciousness of the Center for diagnosis and treatment of epilepsy, and sleep disorders in children and adolescents at the department neurology, neurosurgery and medical genetics SPbGPMU.Materials and methods. For more accurate diagnosis and treatment at the Center conducted a comprehensive examination, including video-EEG оf 527 children aged 1 month to 18 years. A clinical trial study included medical cases, assessment of neurological and somatic status, the study of seizure types and forms of the disease. Instrumental methods of examination were determined by EEG and MRI studies of the brain.Main results. Comprehensive survey of sick children with monitoring video-EEG revealed that 317 children (60,1% had epileptic paroxysms and 210 children (39,8% – non-epileptic paroxysms. Correction treatment was performed in 284 (89,5% children with epileptic paroxysms and altered the treatment in 190 (90,4% children with epileptic paroxysms.Conclusion. The presented clinical data show the high effectiveness of the Centre in the diagnosis and treatment of children with paroxysmal disorders of consciousness. The accumulated experience in the Center confirms the relevance of the creation of the structure of scientific and educational institutions specialized centers in which patients will be given to high-quality medical care.

  2. Race, Pain, and Beliefs Associated with Interest in Complementary and Alternative Medicine among Inner City Veterans.

    Science.gov (United States)

    Goldstein, Jennifer N; Ibrahim, Said A; Frankel, Eitan S; Mao, Jun J

    2015-08-01

    To investigate the prevalence and determinants of complementary and alternative medicine (CAM) interest level among a racially diverse cohort of inner city veterans who receive primary care at the VA Medical Center. Cross-sectional survey study Philadelphia VA Medical Center Primary care patients (n = 258) METHODS: Interest in CAM was measured using a single item question. Patient treatment beliefs were assessed using validated instruments. We evaluated factors associated with patient interest in CAM using a multivariate logistic regression model. In this sample of 258 inner city primary care VA patients, interest in CAM was high 80% (n = 206). Interest in CAM was strongly associated with African American race [adjusted odds ratio (AOR) 2.19, 95% Confidence Interval (CI) 1.05-4.60, P = 0.037], higher levels of education (AOR 4.33, 95% CI 1.80-10.40, P = 0.001), presence of moderate to severe pain (AOR 2.02, 95% CI 1.02-4.78, P = 0.043), and expectations of benefit from CAM use (AOR 1.21, 95% CI 1.06-1.36, P = 0.004). CAM approaches have broad appeal within this inner city cohort of veterans, particularly among African Americans, those that experience pain and those that expect greater benefit from CAM. These findings may inform the development of patient-centered integrative pain management for veterans. Wiley Periodicals, Inc.

  3. Attitudes towards primary care career in community health centers among medical students in China.

    Science.gov (United States)

    Zhang, Lingling; Bossert, Thomas; Mahal, Ajay; Hu, Guoqing; Guo, Qing; Liu, Yuanli

    2016-07-16

    Very few of the primary care doctors currently working in China's community health centers have a college degree (issued by 5-year medical schools). How to attract college graduates to community services in the future, therefore, has major policy relevance in the government's ongoing efforts to reform community health care and fill in the long-absent role of general physicians in China. This paper examined medical school students' attitudes towards working in communities and the factors that may affect their career choices in primary care to inform policy on this subject. A cross-sectional survey was designed upon the issuance of community health reform policy in 2006 by the Chinese government. The survey was conducted among 2714 medical students from three medical schools in representative regions in China. Binomial and multinomial regression analyses were carried out using a collection of plausible predictors such as place of rearing, income, etc. to assess their willingness to work in communities. Of the 2402 valid responses, besides 5.7 % objection to working in communities, 19.1 % expressed definite willingness. However, the majority (41.5 %) of students only consider community job as a temporary transition, in addition to 33.7 % using it as their backup option. The survey analyses found that medical students who are more likely to be willing to work in communities tend to come from rural backgrounds, have more exposure to community health reform, and possess certain personally held value and fit. To attract more graduates from 5-year medical schools to work in communities, a targeted recruiting approach or admission policy stands a better chance of success. The findings on the influencing factors of medical students' career choice can help inform policymakers, medical educators, and community health managers to improve the willingness of swing students to enter primary care to strengthen basic health services.

  4. A prism of excellence: The Charleston Veterans Administration Nursing Academic Partnership.

    Science.gov (United States)

    Coxe, D Nicole; Conner, Brian T; Lauerer, Joy; Skipper, Janice; York, Janet; Fraggos, Mary; Stuart, Gail W

    2016-01-01

    The Veterans Administration (VA) has been committed to academic affiliate training partnerships for nearly 70 years in efforts to enhance veteran-centric health care. One such effort, the VA Nursing Academy (VANA) program, was developed in 2007 in response to the nationwide nursing shortage and began as a five-year pilot with funding competitively awarded to 15 partnerships between local VA medical centers and schools of nursing. The VANA program evolved into the VA Nursing Academic Partnership (VANAP) program following the initial pilot. This article describes the development and evolution of the Charleston VANAP, which includes the Ralph H Johnson VA Medical Center (RHJ VAMC) and the Medical University of South Carolina College of Nursing (MUSC CON). The VA Office of Academic Affiliations (OAA) funded a large portion of the initial five years of the Charleston VANAP. Once the national funding source ceased, the RHJ VAMC and the MUSC CON entered into a Memorandum of Understanding (MOU) to offer in-kind contributions to the partnership. The Charleston VANAP is the only program in the nation to offer three different nurse trainee programs and this article highlights some of the more notable achievements from each program. The Charleston VANAP is a comprehensive partnership between the RHJ VAMC and the MUSC CON that truly demonstrates a commitment to assure that the very best care be provided to Veterans, our Nation's heroes. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Chronic multisymptom illness complex in Gulf War I veterans 10 years later.

    Science.gov (United States)

    Blanchard, Melvin S; Eisen, Seth A; Alpern, Renee; Karlinsky, Joel; Toomey, Rosemary; Reda, Domenic J; Murphy, Frances M; Jackson, Leila W; Kang, Han K

    2006-01-01

    Prior research has demonstrated that shortly after the 1991 Gulf War (Gulf War I), chronic multisymptom illness (CMI) was more common among deployed veterans than among nondeployed veterans. The aims of the current study were to determine the prevalence of CMI among deployed and nondeployed veterans 10 years after Gulf War I, compare the distribution of comorbid conditions, and identify prewar factors associated with CMI. Cross-sectional data collected from 1,061 deployed veterans and 1,128 nondeployed veterans examined between 1999 and 2001 were analyzed. CMI prevalence was 28.9% among deployed veterans and 15.8% among nondeployed veterans (odds ratio = 2.16, 95% confidence interval: 1.61, 2.90). Deployed and nondeployed veterans with CMI had similarly poorer quality-of-life measures and higher prevalences of symptom-based medical conditions, metabolic syndrome, and psychiatric disorders. Diagnoses of prewar anxiety disorders (not related to post-traumatic stress disorder) and depression were associated with CMI among both deployed and nondeployed veterans. Nicotine dependence and veteran-reported physician-diagnosed infectious mononucleosis were associated with CMI among deployed veterans, and migraine headaches and gastritis were associated with CMI among nondeployed veterans. CMI continues to be substantially more prevalent among deployed veterans than among nondeployed veterans 10 years after Gulf War I, but it manifests similarly in both groups. It is likely to be a common, persistent problem among veterans returning from the current Gulf War.

  6. Implementation of epic beaker anatomic pathology at an academic medical center

    Directory of Open Access Journals (Sweden)

    John Larry Blau

    2017-01-01

    Full Text Available Background: Beaker is a relatively new laboratory information system (LIS offered by Epic Systems Corporation as part of its suite of health-care software and bundled with its electronic medical record, EpicCare. It is divided into two modules, Beaker anatomic pathology (Beaker AP and Beaker Clinical Pathology. In this report, we describe our experience implementing Beaker AP version 2014 at an academic medical center with a go-live date of October 2015. Methods: This report covers preimplementation preparations and challenges beginning in September 2014, issues discovered soon after go-live in October 2015, and some post go-live optimizations using data from meetings, debriefings, and the project closure document. Results: We share specific issues that we encountered during implementation, including difficulties with the proposed frozen section workflow, developing a shared specimen source dictionary, and implementation of the standard Beaker workflow in large institution with trainees. We share specific strategies that we used to overcome these issues for a successful Beaker AP implementation. Several areas of the laboratory-required adaptation of the default Beaker build parameters to meet the needs of the workflow in a busy academic medical center. In a few areas, our laboratory was unable to use the Beaker functionality to support our workflow, and we have continued to use paper or have altered our workflow. In spite of several difficulties that required creative solutions before go-live, the implementation has been successful based on satisfaction surveys completed by pathologists and others who use the software. However, optimization of Beaker workflows has continued to be an ongoing process after go-live to the present time. Conclusions: The Beaker AP LIS can be successfully implemented at an academic medical center but requires significant forethought, creative adaptation, and continued shared management of the ongoing product by

  7. Multimedia-based courseware in the Virtual Learning Center at the Hannover Medical School.

    Science.gov (United States)

    Matthies, H K; von Jan, U; Porth, A J; Tatagiba, M; Stan, A C; Walter, G F

    2000-01-01

    The commercial use of the World Wide Web causes an extensive change in information technology. Web browser are becoming the universal front-end for all kinds of client-server applications. The possibilities of telematics offer a base for multimedia applications, for instance telelearning. Learning is not limited by geography and does not cause pressure of time by the user. The development of such multimedia information and communication systems demands cooperative working teams of authors, who are able to master several areas of medical knowledge as well as the presentation of these using different multimedia facilities. A very important part of graphic design in the context of multimedia applications is the creation and interactive use of images (still, moving). The growth and the complexity of medical knowledge as well as the need for continuous, fast, and economically feasible maintenance impose requirements on the media used for medical education and training. Web-based courseware in the Virtual Learning Center at the Hannover Medical School is an innovative education resource for medical students and professionals.

  8. 75 FR 32670 - Copayments for Medications After June 30, 2010

    Science.gov (United States)

    2010-06-09

    ... our analysis of the average rate of growth of the CPI-P, the current regulatory methodology..., Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental Care; 64.012... Care; 64.015, Veterans State Nursing Home Care; 64.016, Veterans State Hospital Care; 64.018, Sharing...

  9. 75 FR 68975 - Supportive Services for Veteran Families Program

    Science.gov (United States)

    2010-11-10

    ..., National Center for Homelessness Among Veterans, Supportive Services for Veteran Families Program Office... services pursuant to payments from the grantee be State-licensed because ``home run daycare and other... some jurisdictions, may include home run daycares. The commenter also requested that VA consider...

  10. Veterans' Preferences for Remote Management of Chronic Conditions.

    Science.gov (United States)

    Sedlander, Erica; Barboza, Katherine C; Jensen, Ashley; Skursky, Nicole; Bennett, Katelyn; Sherman, Scott; Schwartz, Mark

    2017-07-26

    The Veterans Health Administration (VA) is investing considerable resources into providing remote management care to patients for disease prevention and management. Remote management includes online patient portals, e-mails between patients and providers, follow-up phone calls, and home health devices to monitor health status. However, little is known about patients' attitudes and preferences for this type of care. This qualitative study was conducted to better understand patient preferences for receiving remote care. Ten focus groups were held comprising 77 patients with hypertension or tobacco use history at two VA medical centers. Discussion questions focused on experience with current VA remote management efforts and preferences for receiving additional care between outpatient visits. Most participants were receptive to remote management for referrals, appointment reminders, resource information, and motivational and emotional support between visits, but described challenges with some technological tools. Participants reported that remote management should be personalized and tailored to individual needs. They expressed preferences for frequency, scope, continuity of provider, and mode of communication between visits. Most participants were open to nonclinicians contacting them as long as they had direct connection to their medical team. Some participants expressed a preference for a licensed medical professional. All groups raised concerns around confidentiality and privacy of healthcare information. Female Veterans expressed a desire for gender-sensitive care and an interest in complementary and alternative medicine. The findings and specific recommendations from this study can improve existing remote management programs and inform the design of future efforts.

  11. An experience of liver transplantation in Latin America: a medical center in Colombia.

    Science.gov (United States)

    Santos, Oscar; Londoño, Mauricio; Marín, Juan; Muñoz, Octavio; Mena, Álvaro; Guzmán, Carlos; Hoyos, Sergio; Restrepo, Juan; Arbeláez, María; Correa, Gonzalo

    2015-01-01

    Liver transplantation is the treatment of choice for acute and chronic liver failure, for selected cases of tumors, and for conditions resulting from errors in metabolism. This paper reports the experience of a medical center in Latin America. Were conducted 305 orthotopic liver transplantations on 284 patients between 2004 and 2010. Of these patients, 241 were adults undergoing their first transplantation. The average age of patients was 52 years old, and 62% of the individuals were male. The most common indication was alcoholic cirrhosis. The rate of patient survival after 1 and 5 years was 82 and 72% respectively. The rate of liver graft survival after 1 and 5 years was 78 and 68% respectively. The main cause of death was sepsis. Complications in the hepatic artery were documented for 5% of the patients. Additionally, 14.5% of the patients had complications in the biliary tract. Infections were found in 41% of the individuals. Acute rejection was observed in 30% of the subjects, and chronic rejection in 3%. In conclusion, liver transplantation at our medical center in Colombia offers good mid-term results, with a complication rate similar to that reported by other centers around the world.

  12. Detecting Postpartum Depression in Referents to Medical and Health Centers in Hamadan City

    Directory of Open Access Journals (Sweden)

    F. Shobeiri

    2007-10-01

    Full Text Available Introduction & Objective: Pregnancy and childbirth are significant developmental excitable for most women. Physical, intrapersonal and relational adaptations are needed to adjust successfully to pregnancy and delivery. Postpartum depression is a serious psychiatric disorder and the adverse impact on infants has been noted. The purpose of this study was to detect postpartum depression in referents to medical and health centers in Hamadan city.Materials & Methods: A descriptive and cross-sectional study involving 400 women completed the Beck Depression Inventory (BDI within 2-8 weeks of delivery was conducted in urban health centers in Hamadan city, Iran. Data were collected through interviews with women in the clinics in the health centers. Data processing and statistical analysis were performed using SPSS 10.0.Results: The results revealed that majority of women (68.0% were considered normal. Depression was detected in 32.0% of women. Out of these 19.0, 4.0 and 9.0% were mild, moderate and severe depression, respectively. There were statistically significant differences between postpartum depression and age, number of delivery, education, job and husband's job (P=0.000.Conclusion: Nearly 32.0% of selected women had depression. Therefore, it is important for medical personnel to be well versed in the course and treatment of postpartum depression. Post partum depression should be screened and treated as early as possible for several reasons. It can cause significant suffering for the woman who experiences it, and it can have deleterious consequences for the newborn.

  13. Dialysis vascular access management by interventional nephrology programs at University Medical Centers in the United States.

    Science.gov (United States)

    Vachharajani, Tushar J; Moossavi, Shahriar; Salman, Loay; Wu, Steven; Dwyer, Amy C; Ross, Jamie; Dukkipati, Ramanath; Maya, Ivan D; Yevzlin, Alexander S; Agarwal, Anil; Abreo, Kenneth D; Work, Jack; Asif, Arif

    2011-01-01

    The development of interventional nephrology has undoubtedly led to an improvement in patient care at many facilities across the United States. However, these services have traditionally been offered by interventional nephrologists in the private practice arena. While interventional nephrology was born in the private practice setting, several academic medical centers across the United States have now developed interventional nephrology programs. University Medical Centers (UMCs) that offer interventional nephrology face challenges, such as smaller dialysis populations, limited financial resources, and real or perceived political "turf" issues." Despite these hurdles, several UMCs have successfully established interventional nephrology as an intricate part of a larger nephrology program. This has largely been accomplished by consolidating available resources and collaborating with other specialties irrespective of the size of the dialysis population. The collaboration with other specialties also offers an opportunity to perform advanced procedures, such as application of excimer laser and endovascular ultrasound. As more UMCs establish interventional nephrology programs, opportunities for developing standardized training centers will improve, resulting in better quality and availability of nephrology-related procedures, and providing an impetus for research activities. © 2011 Wiley Periodicals, Inc.

  14. Families' perceptions of end-of-life care in Veterans Affairs versus non-Veterans Affairs facilities.

    Science.gov (United States)

    Lu, Hien; Trancik, Emily; Bailey, F Amos; Ritchie, Christine; Rosenfeld, Kenneth; Shreve, Scott; Furman, Christian; Smith, Dawn; Wolff, Catherine; Casarett, David

    2010-08-01

    The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA facilities. Retrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities. Five Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics. Patients were eligible if they received any care from a participating VA facility in the last month of life and if they died in an inpatient setting. One family member per patient completed the survey. In bivariate analysis, patients who died in VA facilities (n = 520) had higher mean satisfaction scores compared to those who died in non-VA facilities (n = 89; 59 versus 51; rank sum test p = 0.002). After adjusting for medical center, the overall score was still significantly higher for those dying in the VA (beta = 0.07; confidence interval [CI] = 0.02-0.11; p = 0.004), as was the domain measuring care around the time of death (beta = 0.11; CI = 0.04-0.17; p = 0.001). Families of patients who died in VA facilities rated care as being better than did families of those who died in non-VA facilities. These results provide preliminary evidence that the VA's investment in end-of-life care has contributed to improvements in care in VA facilities compared to non-VA facilities.

  15. Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

    Directory of Open Access Journals (Sweden)

    H Zare Ahmadabadi

    2007-07-01

    Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

  16. The effect of training in primary health care centers on medical students' clinical skills.

    Science.gov (United States)

    Abdullatif Alnasir, Faisal; Jaradat, Ahmed Abdel-Karim

    2013-01-01

    Medical students' effective clinical skills training are an important goal of any medical school. When adequate, graduate doctors will have sufficient skills to consult a patient by taking proper history and conducting appropriate physical examination. The question under scrutiny is the optimal place for providing such training. Since the aim is to graduate general physicians, many literatures highlighted the importance of implementing such training in the primary health care centers. A special clinical skills training program was developed for the Year 4 pre-clerkship medical students of the Arabian Gulf University during the academic year 2011-2012. It was important for these students to acquire certain skills before transferring to the clerkship phase where they deal directly with patients. For the 130 students involved in this study, a self-assessment and clinical exam were conducted at the beginning and end of the program. The study showed that students benefited greatly from this training program with significant differences between their preexisting known skills and clinical skills acquired by the end of the program. Primary care centers are ideal places for optimal training because of small group training setting that is one tutor to two students and of the advantage that students face real patient environment.

  17. Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital.

    Science.gov (United States)

    Schultz, Carl H; Koenig, Kristi L; Alassaf, Wajdan

    2015-10-01

    As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population's health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented.

  18. Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes

    Directory of Open Access Journals (Sweden)

    Jia H

    2017-03-01

    Full Text Available Huanguang Jia,1 Qinglin Pei,1 Charles T Sullivan,1 Diane C Cowper Ripley,1 Samuel S Wu,1 W Bruce Vogel,1 Xinping Wang,1 Douglas E Bidelspach,2 Jennifer L Hale-Gallardo,1 Barbara E Bates3 1Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 2Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC, 3Aleda E. Lutz VA Medical Center, Saginaw, MI, USA Introduction: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors’ functional recovery and daily living activities. The US Department of Veterans Affairs (VA places veterans needing post-acute institutional care in private community nursing homes (CNHs. These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans’ health services as well as the geographic variation of the service utilization. Aim: The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. Methods: This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents for the study CNHs was linked with veterans’ inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation

  19. Veterans' Mental Health in Higher Education Settings: Services and Clinician Education Needs.

    Science.gov (United States)

    Niv, Noosha; Bennett, Lauren

    2017-06-01

    Utilization of the GI Bill and attendance at higher education institutions among student veterans have significantly increased since passage of the Post-9/11 GI Bill. Campus counseling centers should be prepared to meet the mental health needs of student veterans. This study identified the mental health resources and services that colleges provide student veterans and the education needs of clinical staff on how to serve student veterans. Directors of mental health services from 80 California colleges completed a semistructured phone interview. Few schools track the number, demographic characteristics, or presenting needs of student veterans who utilize campus mental health services or offer priority access or special mental health services for veterans. Directors wanted centers to receive education for an average of 5.8 veteran-related mental health topics and preferred workshops and lectures to handouts and online training. Significant training needs exist among clinical staff of campus mental health services to meet the needs of student veterans.

  20. Perceived Benefits and Barriers about Self-medication among Women Referring to Health Center in Qom City - 2016

    Directory of Open Access Journals (Sweden)

    Ahmad Rahbar

    2017-05-01

    Full Text Available Abstract Background: Self-medication is one of the biggest problems of social, health and economic societies such as Iran. The aim of this study was to determine the benefits and barriers about self-medication among women referring to health center in Qom city. Materials and Methods: This cross-sectional descriptive-analytical study carried out on women referred to health centers in Qom city- 2016. In the current study, 226 people were selected from among the health centers by multistage sampling. A standard questionnaire was used on knowledge about self-medication, perceived benefits, perceived barriers and self-medication. Data were analyzed by SPSS V.20 using independent t-test and Chi-square. Results: According to the results of this study, 74.3 percent of women had a history of self-medication that 43.8 percent of them was in the past 6 months. The mean of knowledge about self-medication and perceived barriers in people with a history of self-medication was significantly higher than those who had not a history of self-medication (p<0.05. While, the perceived benefits was not significantly associated with a history of self-medication (p=0.79. Conclusion: Given the high prevalence of self-medication and the relationship between knowledge and perceived barriers with self-medication, therefore, educational program is necessary for women about the effects and consequences of self-medication through the media.

  1. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Budget, & Performance VA Center for Innovation (VACI) Agency Financial Report (AFR) Budget ... Management Services Veterans Service Organizations Office of Accountability & Whistleblower ...

  2. Neural Markers and Rehabilitation of Executive Functioning in Veterans with TBI and PTSD

    Science.gov (United States)

    2012-10-01

    screening measures to ensure that Veterans meet study criteria. We have found at least three veterans so far have reported having had welding ...report surgical metal implants . We are requiring these veterans to provide medical documentation of these implants so that the Neuroimaging lab

  3. 76 FR 82212 - Grants for Transportation of Veterans in Highly Rural Areas

    Science.gov (United States)

    2011-12-30

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO01 Grants for Transportation of Veterans in Highly Rural Areas AGENCY... to ``RIN 2900-AO01, Grants for Transportation of Veterans in Highly Rural Areas.'' Copies of comments... award grants to eligible entities to assist veterans in highly rural areas to travel to VA medical...

  4. The impact of the lack of health insurance: how should academic medical centers and medical schools respond?

    Science.gov (United States)

    Coleman, David L

    2006-08-01

    The lack of health insurance has significant deleterious effects on the health of individual patients and creates substantial financial pressure on health care institutions. Despite the historical role of academic medical centers (AMCs) and medical schools in caring for the uninsured, financial shortfalls have increased pressure on these institutions to restrict care of this population. Limiting care of the uninsured, however, conflicts with the ethical foundations of academic medicine and risks further harm to the health of this population. Instead of restricting care, the effects of uninsurance should be mitigated through the joint efforts of medical schools and AMCs by measuring clinical work using work Relative Value Units rather than collections; recognizing faculty who provide care for the uninsured in the promotions process; adjusting billing rates for clinical services according to patients' ability to pay; delivering one standard of care irrespective of insurance status; continuing to evaluate the impact of uninsurance and intervention strategies; providing leadership in measuring and improving the quality of care; ensuring that trainees and the public are familiar with the effects of a lack of health insurance; and assisting safety net providers by providing educational materials pertinent to their respective patient populations and more fully integrating these providers into the academic community. Although all physicians in the private and public sectors should share in the care of the uninsured, academic medicine must remain faithful to its historical role of providing care to the uninsured and should improve the health of the uninsured through a proactive strategy involving advocacy, clinical care, education, and research.

  5. Lessons learned and two years clinical experience in implementing the Medical Diagnostic Imaging Support (MDIS) System at Madigan Army Medical Center

    Science.gov (United States)

    Smith, Donald V.; Smith, Suzy; Bender, Gregory N.; Carter, Jon R.; Cawthon, Michael A.; Leckie, Robert G.; Weiser, John C.; Romlein, John R.; Goeringer, Fred

    1994-05-01

    The Medical Diagnostic Imaging Support System at Madigan Army Medical Center has been operational in a phase approach since March 1992. Since then, nearly all image acquisition has been digital with progressively increasing primary soft copy diagnosis utilized. Nearly four terabytes of data will have been archived in compressed form by the two year anniversary including more than 300,000 Computed Radiography images.

  6. Proposed finding of no significant impact for the Sakakawea Medical Center coal-fired heating plant

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-01

    The Department of Energy (the Department) has prepared an environmental assessment (Assessment) (DOE/EA-0949) to identify and evaluate the potential environmental impacts of a proposed action at the Sakakawea Medical Center (the Center) in Hazen, North Dakota. The proposed action would replace the existing No. 2 fuel oil-fired boilers supplemented by electric reheat with a new coal-fired hot water heating plant, using funds provided from a grant under the Institutional Conservation Program. Based on the analysis in DOE/EA-0949, the Department has determined that the proposed action is not a major federal action significantly affecting the quality of the human environment, within the meaning of the National Environmental Policy Act (NEPA) of 1969, as amended. Therefore, preparation of an Environmental Impact Statement is not required, and the Department is issuing this Finding of No Significant Impact (Finding).

  7. Medication adherence: process for implementation

    OpenAIRE

    Mendys P; Zullig LL; Burkholder R; Granger BB; Bosworth HB

    2014-01-01

    Phil Mendys,1,2 Leah L Zullig,3 Rebecca Burkholder,4 Bradi B Granger,5 Hayden B Bosworth3,5,6 1Pfizer Inc, Medical Affairs, New York, NY, USA; 2Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA; 3Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 4National Consumers League, Washington, DC, USA; 5School of Nursing, Duke University, Durham, NC, USA; 6Department of Medicine and Psychiatry, School of Medicine, Du...

  8. Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model.

    Science.gov (United States)

    Yehia, Baligh R; Agwu, Allison L; Schranz, Asher; Korthuis, P Todd; Gaur, Aditya H; Rutstein, Richard; Sharp, Victoria; Spector, Stephen A; Berry, Stephen A; Gebo, Kelly A

    2013-05-01

    The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.

  9. Impact of the seeking safety program on clinical outcomes among homeless female veterans with psychiatric disorders.

    Science.gov (United States)

    Desai, Rani A; Harpaz-Rotem, Ilan; Najavits, Lisa M; Rosenheck, Robert A

    2008-09-01

    Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs. The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N=91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of posttraumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days. Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans

  10. Implementing teams in a patient-centered medical home residency practice: lessons learned.

    Science.gov (United States)

    Markova, Tsveti; Mateo, Maribeth; Roth, Linda M

    2012-01-01

    The "new model of care" calls for a new approach for primary care delivery that focuses on patient centeredness, quality, safety, effective and efficient care, and interdisciplinary teamwork. Medical education needs to parallel this health care reorganization. Implementing a team approach in a residency practice, especially in ambulatory settings, poses unique challenges. We introduced interdisciplinary teams in a family medicine residency site, integrating clinical and educational objectives. We report our challenges and successes in the transformational journey to a patient-centered medical home, for which a team approach is critical to achieving high quality care. Establishing high-functioning interdisciplinary teams takes leadership commitment; the engagement of everyone in the practice; investment in staff, resident, and faculty development; and clear communication of vision and goals. Integration of clinical and educational objectives can be powerfully synergistic. Clinical, organizational, and educational outcomes are needed to evaluate impact.

  11. Putting patients first: a novel patient-centered model for medical enterprise success.

    Science.gov (United States)

    Dhawan, Naveen

    2014-01-01

    This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise.

  12. Assessment of an automatic robotic arm for dispensing of chemotherapy in a 2500-bed medical center

    OpenAIRE

    Chen, Wen-Hwei; Shen, Li-Jiuan; Guan, Ru-Jiun; Lin Wu, Fe-Lin

    2013-01-01

    Automation has long been awaited in parenteral drug dispensing. Pharmacists can benefit much in theory from a good automated device to handle the hazardous drugs used in chemotherapy. This paper describes the performance of the first chemotherapy-dispensing robot in the oncology pharmacy of a 2500-bed medical center. The objective of this paper is two-fold: (1) to assess the robot’s performance in terms of its success rate and to summarize the causes of failure, and (2) to find out if the rob...

  13. Accelerating change: Fostering innovation in healthcare delivery at academic medical centers.

    Science.gov (United States)

    Ostrovsky, Andrey; Barnett, Michael

    2014-03-01

    Academic medical centers (AMCs) have the potential to be leaders in the era of healthcare delivery reform, but most have yet to display a commitment to delivery innovation on par with their commitment to basic research. Several institutional factors impede delivery innovation including the paucity of adequate training in design and implementation of new delivery models and the lack of established pathways for academic career advancement outside of research. This paper proposes two initiatives to jumpstart disruptive innovation at AMCs: an institutional "innovation incubator" program and a clinician-innovator career track coupled with innovation training programs. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Towards a person-centered medical education: challenges and imperatives (I

    Directory of Open Access Journals (Sweden)

    Andrew Miles

    2015-01-01

    Full Text Available It is increasingly claimed that modern medicine has entered into crisis —a crisis of knowledge (uncertainty over what counts as “evidence” for decision-making and what does not, care (a deficit in sympathy, empathy, compassion, dignity, autonomy, patient safety (neglect, iatrogenic injury, malpractice, excess deaths, economic costs (which threaten to bankrupt health systems worldwide and clinical and institutional governance (a failure of basic and advanced management, inspirational and transformational leadership. We believe such a contention to be essentially correct. In the current article, we ask how the delineated components of the crisis can be individually understood in order to allow them to be collectively addressed. We ask how a transition can be effected away from impersonal, decontextualized and fragmented services in the direction of newer models of service provision that are personalized, contextualized and integrated. How, we ask, can we improve healthcare outcomes while simultaneously containing or lowering their costs? In initial answer to such questions —which are of considerable political as well as clinical significance— we assert that a new approach has become necessary, particularly in the context of the current epidemic of multi-morbid and socially complex long term illness. This new approach, we argue, is represented by the development and application of the concepts and methods of person-centered healthcare (PCH, a philosophy and technique in the care of the sick that enables clinicians and health systems to re-introduce humanistic ideals into clinical practice alongside continuing scientific advance, thereby restoring to medicine the humanism it has lost in over a century of empiricism. But the delivery of a person-centered healthcare within health systems requires a person-centered education and training. In this article we consider, then, why person-centered teaching innovations in the undergraduate medical

  15. Dealing with drug-seeking patients: the Tripler Army Medical Center experience.

    Science.gov (United States)

    Lewis, P; Gaule, D

    1999-12-01

    Patients who exhibit drug-seeking behavior are a chronic problem in most health care delivery settings. In June 1996, Tripler Army Medical Center, a tertiary care hospital serving approximately 300,000 beneficiaries, implemented a sole provider program to identify and help such patients. A multidisciplinary sole provider team assigns a sole provider to identified drug seekers. Twice a year, the team scans a printout of all prescriptions for controlled substances to identify suspicious drug usage patterns. The team also accepts referrals from health care providers. This article describes the program and reports on results, problems encountered, and steps taken to improve its efficacy.

  16. Preliminary results of VISX excimer laser myopic photorefractive keratectomy at Cedars-Sinai Medical Center

    Science.gov (United States)

    Maguen, Ezra I.; Berlin, Michael S.; Hofbauer, John; Macy, Jonathan I.; Nesburn, Anthony B.; Papaioannou, Thanassis; Salz, James J.

    1992-08-01

    Sixty-two eyes underwent excimer laser photorefractive keratectomy (PRK) for the correction of myopia at Cedars-Sinai-Medical-Center. The first group of 12 patients are presented with follow up data of ten months postoperatively. The second group of 50 patients are presented with follow up data of three months postoperatively. An in-depth comparison of pre and postoperative refractive data is presented. Comparisons between pre and postoperative corrected and uncorrected Snellen visual acuities are provided in order to asses the functional visual result of the procedure.

  17. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    Science.gov (United States)

    O’Donnell, Alison J.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert; Cronholm, Peter F.

    2016-01-01

    Introduction Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. Methods The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Results Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Conclusion Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care. PMID:26916899

  18. A Randomized Trial of Dialectical Behavior Therapy in High-Risk Suicidal Veterans.

    Science.gov (United States)

    Goodman, Marianne; Banthin, David; Blair, Nicholas J; Mascitelli, Kathryn A; Wilsnack, Jaime; Chen, Jennifer; Messenger, Julie W; Perez-Rodriguez, M Mercedes; Triebwasser, Joseph; Koenigsberg, Harold W; Goetz, Raymond R; Hazlett, Erin A; New, Antonia S

    2016-12-01

    Despite advances in suicide prevention implemented throughout the US Department of Veterans Affairs (VA) including the hiring of Suicide Prevention Coordinators (SPCs) at every VA hospital, enhanced monitoring, and the availability of 24-hour crisis hotline services, suicide by veterans remains a critical problem affecting 20 veterans daily. Few empirically based treatment strategies for suicide prevention for postdeployment military personnel exist. This study aimed to test whether dialectical behavior therapy (DBT), one of the few psychosocial treatments with proven efficacy in diminishing suicidal behavior in individuals with personality disorder, can be applied to veterans irrespective of personality diagnosis. From January 2010 to December 2014, 91 nonpsychotic veterans at high risk for suicide (61 men, 30 women) were randomly assigned to a 6-month treatment trial at a veterans' medical center comparing standard DBT to treatment as usual (TAU) and followed for 6 months after trial completion. Primary outcome was suicide attempts, measured with the Columbia-Suicide Severity Rating Scale, and secondary outcomes were suicide ideation, depression, hopelessness, and anxiety. There were no exclusions pertaining to substance abuse, homelessness, or medical comorbidity. Both DBT and TAU resulted in improvements in suicidal ideation, depression, and anxiety during the course of the 6-month treatment trial that did not differ between treatment arms. Survival analyses for suicide attempts and hospitalizations did not differ between treatment arms. However, DBT subjects utilized significantly more individual mental health services than TAU subjects (28.5 ± 19.6 vs 14.7 ± 10.9, F₁,₇₇ = 11.60, P = .001). This study is the first to examine 6-month DBT in a mostly male, veteran population. Increased mental health treatment service delivery, which included enhanced monitoring, outreach, and availability of a designated SPC, did not yield statistically significant

  19. National Coalition for Homeless Veterans

    Science.gov (United States)

    ... Continues Support of National Campaign to End Veteran Homelessness Nov. 14, 2017 This Veterans Day, Harbor Freight ... support of the national campaign to end veteran homelessness through generous contributions to the National Coalition for ...

  20. Korean War Veterans by State

    Data.gov (United States)

    Department of Veterans Affairs — The spreadsheet of Korean War Veterans by State includes the total Korean War Veteran population for each state and broken out by age and gender. It also includes...

  1. DEVELOPMENT OF CLINICAL SCENARIO’S INFORMATION MODEL IN THE MEDICAL SIMULATION CENTER

    Directory of Open Access Journals (Sweden)

    I. V. Tolmachyov

    2014-01-01

    Full Text Available There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center.Objectives:– to analyze the process of scenario conducting;– to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock with specialist’s help.The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees.By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed.As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones.Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax, pulmonary edema, hypertensive crisis, respiratory

  2. Establishment of exposure dose assessment laboratory in National Radiation Emergency Medical Center (NREMC)

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Jae Ryong; Ha, Wi Ho; Yoon, Seok Won; Han, Eun Ae; Lee, Seung Sook [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2011-10-15

    As unclear industry grown, 432 of the nuclear power plants are operating and 52 of NPPs are under construction currently. Increasing use of radiation or radioisotopes in the field of industry, medical purpose and research such as non-destructive examination, computed tomography and x-ray, etc. constantly. With use of nuclear or radiation has incidence possibility for example the Fukushima NPP incident, the Goiania accident and the Chernobyl Nuclear accident. Also the risk of terror by radioactive material such as Radiological Dispersal Device(RDD) etc. In Korea, since the 'Law on protection of nuclear facilities and countermeasure for radioactive preparedness was enacted in 2003, the Korean institute of Radiological and Medical Sciences(KIRAMS) was established for the radiation emergency medical response in radiological disaster due to nuclear accident, radioactive terror and so on. Especially National Radiation Emergency Medical Center(NREMC) has the duty that is protect citizens from nuclear, radiological accidents or radiological terrors through the emergency medical preparedness. The NREMC was established by the 39-article law on physical protection of nuclear material and facilities and measures for radiological emergencies. Dose assessment or contamination survey should be performed which provide the radiological information for medical response. For this reason, the NREMC establish and re-organized dose assessment system based on the existing dose assessment system of the NREMC recently. The exposure dose could be measured by physical and biological method. With these two methods, we can have conservative dose assessment result. Therefore the NREMC established the exposure dose assessment laboratory which was re-organized laboratory space and introduced specialized equipment for dose assessment. This paper will report the establishment and operation of exposure dose assessment laboratory for radiological emergency response and discuss how to enhance

  3. An evolving integrative treatment program for military sexual trauma (MST) and one veteran's experience.

    Science.gov (United States)

    Ferdinand, Lisa G; Kelly, Ursula A; Skelton, Kelly; Stephens, Kisha J; Bradley, Bekh

    2011-01-01

    Military sexual trauma (MST) increases the risk for Posttraumatic Stress Disorder (PTSD) and multiple other comorbidities, presenting substantial challenges for nurses and psychiatric and medical clinicians. A specialized VA Medical Center outpatient program is patterned after Herman's three-phased, empirically-supported, recovery treatments. We use a case example of a female veteran MST survivor to illustrate our treatment model. She presented to our program meeting diagnostic criteria for PTSD, Major Depressive Disorder, and a history of substance abuse. Post-treatment she demonstrated improved scores on measures of PTSD, quality of life, and socialization. This model shows promise for treatment of MST survivors with PTSD.

  4. The tele-interpreter service at the Bangkok Hospital Medical Center, Thailand.

    Science.gov (United States)

    Jaroensawat, Boonthida; Wankijcharoen, Somsak

    2013-01-01

    Thailand has become one of the most famous medical hub countries, which is reflected in the increasing number of international patients visiting the Bangkok Hospital Medical Center (BMC). In response, the Interpreter Department at BMC has been established to provide translation for non-English speaking patients. Overtime the Interpreter Department frequently reaches maximum capacity when providing prompt services on demand, resulting in long waiting times and delayed medical treatment. BMC has foreseen the necessity to implement a tele-interpreter system via videoconferencing technology to provide effective translations in the medical environment where delay is usually not tolerated. Tele-interpretation allows doctors to simply select a language icon on their Wi-Fi IP telephone to instantly connect to an interpreter. After implementation in 2oo9, the overall customer satisfaction index for the Interpreter Department increased from 64.5% in Quarter 1 to 85.5% in Quarter 3 of 2011. The tele-interpretation system is currently the closest approximation to the face-to-face interpretation method.

  5. Military service member and veteran self reports of efficacy of cranial electrotherapy stimulation for anxiety, posttraumatic stress disorder, insomnia, and depression.

    Science.gov (United States)

    Kirsch, Daniel L; Price, Larry R; Nichols, Francine; Marksberry, Jeffrey A; Platoni, Katherine T

    2014-01-01

    Cranial electrotherapy stimulation (CES) is being prescribed for service members and veterans for the treatment of anxiety, posttraumatic stress disorder (PTSD), insomnia and depression. The purpose of this study was to examine service members' and veterans' perceptions of the effectiveness and safety of CES treatment. Service members and veterans (N=1,514) who had obtained a CES device through the Department of Defense or Veterans Affairs Medical Center from 2006-2011 were invited to participate in the web based survey via email. One hundred fifty-two participants returned questionnaires. Data were analyzed using descriptive statistics. Participants reported clinical improvement of 25% or more from using CES for anxiety (66.7%), PTSD (62.5%), insomnia (65.3%) and depression (53.9%). The majority of these participants reported clinical improvement of 50% or more. Respondents also perceived CES to be safe (99.0%). Those individuals who were not taking any prescription medication rated CES more effective than the combined CES and prescription medication group. CES provides service members and veterans with a safe, noninvasive, nondrug, easy to use treatment for anxiety, PTSD, insomnia, and depression that can be used in the clinical setting or self-directed at home.

  6. Set up and operation for medical radiation exposure quality control system of health promotion center

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Su; Kim, Jung Min [Korea University,Seoul (Korea, Republic of); Jung, Hae Kyoung [Dept. of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Sungnam (Korea, Republic of)

    2016-03-15

    In this study, standard model of medical radiation dosage quality control system will be suggested and the useful of this system in clinical field will be reviewed. Radiation dosage information of modalities are gathered from digital imaging and communications in medicine(DICOM) standard data(such as DICOM dose SR and DICOM header) and stored in database. One CT scan, two digital radiography modalities and two mammography modalities in one health promotion center in Seoul are used to derive clinical data for one month. After 1 months research with 703 CT scans, the study shows CT 357.9 mGy·cm in abdomen and pelvic CT, 572.4 mGy·cm in brain without CT, 55.9 mGy·cm in calcium score/heart CT, screening CT at 54 mGy·cm in chest screening CT(low dose screening CT scan), 284.99 mGy·cm in C-spine CT and 341.85 mGy·cm in L-spine CT as health promotion center reference level of each exam. And with 1955 digital radiography cases, it shows 274.0 mGy·cm{sup 2} and for mammography 6.09 mGy is shown based on 536 cases. The use of medical radiation shall comply with the principles of justification and optimization. This quality management of medical radiation exposure must be performed in order to follow the principle. And the procedure to reduce the radiation exposure of patients and staff can be achieved through this. The results of this study can be applied as a useful tool to perform the quality control of medical radiation exposure.

  7. Addressing the Needs of Transgender Military Veterans: Better Access and More Comprehensive Care

    OpenAIRE

    Dietert, Michelle; Dentice, Dianne; Keig, Zander

    2017-01-01

    Abstract Purpose: There is a gap in social science literature addressing issues of access and quality of care for transgender military veterans. Psychologists, medical doctors, and other health professionals are beginning to address some of the barriers present in the Department of Veterans Affairs (VA) system that affect veterans who are also transgender and intersex. Over a 7-year period, between 2006 and 2013, 2600 transgender veterans were served by the VA. Data from several surveys revea...

  8. US veterans and their unique issues: enhancing health care professional awareness.

    Science.gov (United States)

    Olenick, Maria; Flowers, Monica; Diaz, Valerie J

    2015-01-01

    United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18-44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies, and utilizes veteran clinical faculty.

  9. Nocardiosis: a 15-year experience in a tertiary medical center in Israel.

    Science.gov (United States)

    Rosman, Yossi; Grossman, Ehud; Keller, Nathan; Thaler, Michael; Eviatar, Tali; Hoffman, Chen; Apter, Sarah

    2013-09-01

    The objective of this study is to characterize the common risk factors, clinical presentation, imaging findings, treatment and outcome of nocardial infection. A retrospective cohort study. We reviewed the charts of all patients with nocardiosis in the Chaim Sheba Medical Center, a tertiary medical center in Israel, between the years 1996 and 2011. A total of 39 patients who had positive culture of Nocardia were analyzed. The majority of our patients were immunocompromised (74.5%), mostly due to corticosteroid therapy. None had HIV/AIDS. The clinical presentation was either acute or a chronic smoldering illness. The three major clinical syndromes were pleuropulmonary, neurological and skin/soft tissue infection about 20.5% each. Pathology in the lungs was seen in most of the patients by CT scan; discrete nodules and wedge shaped pleural based consolidations were the most frequent findings. Brain lesions consistent with abscesses were detected in 10 patients by brain imaging. Some cases had relapsing disease in spite of antimicrobial treatment. 25% of examined isolates were resistant to trimethoprim/sulfamethoxazole. The duration of intravenous antimicrobial treatment ranged from one month to over a year in the severe cases. One year mortality rate was 32%. Nocardiosis requires a high clinical index of suspicion in order to diagnose and treat promptly. Disease extent and bacterial susceptibility have important implications for prognosis and treatment. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  10. Health information security: a case study of three selected medical centers in iran.

    Science.gov (United States)

    Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Sheikhtaheri, Abbas

    2013-03-01

    Health Information System (HIS) is considered a unique factor in improving the quality of health care activities and cost reduction, but today with the development of information technology and use of internet and computer networks, patients' electronic records and health information systems have become a source for hackers. This study aims at checking health information security of three selected medical centers in Iran using AHP fuzzy and TOPSIS compound model. To achieve that security measures were identified, based on the research literature and decision making matrix using experts' points of view. Among the 27 indicators, seven indicators were selected as effective indicators and Fuzzy AHP technique was used to determine the importance of security indicators. Based on the comparisons made between the three selected medical centers to assess the security of health information, it is concluded that Chamran hospital has the most acceptable level of security and attention in three indicators of "verification and system design, user access management, access control system", Al Zahra Hospital in two indicators of "access management and network access control" and Amin Hospital in "equipment safety and system design". In terms of information security, Chamran Hospital ranked first, Al-Zahra Hospital ranked second and Al- Zahra hospital has the third place.

  11. [Causes of death in patients with HIV infection in two Tunisian medical centers].

    Science.gov (United States)

    Chelli, Jihène; Bellazreg, Foued; Aouem, Abir; Hattab, Zouhour; Mesmia, Hèla; Lasfar, Nadia Ben; Hachfi, Wissem; Masmoudi, Tasnim; Chakroun, Mohamed; Letaief, Amel

    2016-01-01

    Antiretroviral tritherapy has contributed to a considerable reduction in HIV-related mortality. The causes of death are dominated by opportunistic infections in developing countries and by cardiovascular diseases and cancer in developed countries. To determine the causes and risk factors associated with death in HIV-infected patients in two Tunisian medical centers. cross-sectional study of HIV-infected patients over 15 years treated at Sousse and Monastir medical centers between 2000 and 2014. Death was considered related to HIV if its primary cause was AIDS-defining illness or if it was due to an opportunistic infection of unknown etiology with CD4 HIV if its primary cause wasn't an AIDS defining illness or if it was due to an unknown cause if no information was available. Two hundred thirteen patients, 130 men (61%) and 83 women (39%), average age 40 ± 11 years were enrolled in the study. Fifty four patients died, the mortality rate was 5.4/100 patients/year. Annual mortality rate decreased from 5.8% in 2000-2003 to 2.3% in 2012-2014. Survival was 72% at 5 years and 67% at 10 years. Death events were associated with HIV in 70.4% of cases. The leading causes of death were pneumocystis carinii pneumonia and cryptococcal meningitis in 6 cases (11%) each. Mortality risk factors were a personal history of opportunistic infections, duration of antiretroviral therapy HIV in Tunisia.

  12. Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students

    Directory of Open Access Journals (Sweden)

    George W. Saba

    2014-04-01

    Full Text Available Background: To encourage medical students’ use of patient-centered skills in core clerkships, we implemented and evaluated a Telephone Follow-up Curriculum focusing on three communication behaviors: tailoring education to patients’ level of understanding, promoting adherence by anticipating obstacles, and ensuring comprehension by having patients repeat the plans. Methods: The intervention group consisted of two different cohorts of third-year medical students in longitudinal clerkships (n=41; traditional clerkship students comprised the comparison group (n =185. Intervention students telephoned one to four patients 1 week after seeing them in outpatient clinics or inpatient care to follow up on recommendations. We used surveys, focus groups, and clinical performance examinations to assess student perception, knowledge and skills, and behavior change. Results: Students found that the curriculum had a positive impact on patient care, although some found the number of calls excessive. Students and faculty reported improvement in students’ understanding of patients’ health behaviors, knowledge of patient education, and attitudes toward telephone follow-up. Few students changed patient education behaviors or called additional patients. Intervention students scored higher in some communication skills on objective assessments. Conclusion: A patient-centered communication curriculum can improve student knowledge and skills. While some intervention students perceived that they made too many calls, our data suggest that more calls, an increased sense of patient ownership, and role modeling by clerkship faculty may ensure incorporation and application of skills.

  13. Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students.

    Science.gov (United States)

    Saba, George W; Chou, Calvin L; Satterfield, Jason; Teherani, Arianne; Hauer, Karen; Poncelet, Ann; Chen, Huiju Carrie

    2014-01-01

    To encourage medical students' use of patient-centered skills in core clerkships, we implemented and evaluated a Telephone Follow-up Curriculum focusing on three communication behaviors: tailoring education to patients' level of understanding, promoting adherence by anticipating obstacles, and ensuring comprehension by having patients repeat the plans. The intervention group consisted of two different cohorts of third-year medical students in longitudinal clerkships (n=41); traditional clerkship students comprised the comparison group (n = 185). Intervention students telephoned one to four patients 1 week after seeing them in outpatient clinics or inpatient care to follow up on recommendations. We used surveys, focus groups, and clinical performance examinations to assess student perception, knowledge and skills, and behavior change. Students found that the curriculum had a positive impact on patient care, although some found the number of calls excessive. Students and faculty reported improvement in students' understanding of patients' health behaviors, knowledge of patient education, and attitudes toward telephone follow-up. Few students changed patient education behaviors or called additional patients. Intervention students scored higher in some communication skills on objective assessments. A patient-centered communication curriculum can improve student knowledge and skills. While some intervention students perceived that they made too many calls, our data suggest that more calls, an increased sense of patient ownership, and role modeling by clerkship faculty may ensure incorporation and application of skills.

  14. Population health and the academic medical center: the time is right.

    Science.gov (United States)

    Gourevitch, Marc N

    2014-04-01

    Optimizing the health of populations, whether defined as persons receiving care from a health care delivery system or more broadly as persons in a region, is emerging as a core focus in the era of health care reform. To achieve this goal requires an approach in which preventive care is valued and "nonmedical" determinants of patients' health are engaged. For large, multimission systems such as academic medical centers, navigating the evolution to a population-oriented paradigm across the domains of patient care, education, and research poses real challenges but also offers tremendous opportunities, as important objectives across each mission begin to align with external trends and incentives. In clinical care, opportunities exist to improve capacity for assuming risk, optimize community benefit, and make innovative use of advances in health information technology. Education must equip the next generation of leaders to understand and address population-level goals in addition to patient-level needs. And the prospects for research to define strategies for measuring and optimizing the health of populations have never been stronger. A remarkable convergence of trends has created compelling opportunities for academic medical centers to advance their core goals by endorsing and committing to advancing the health of populations.

  15. Increasing Therapist Productivity: Using Lean Principles in the Rehabilitation Department of an Academic Medical Center.

    Science.gov (United States)

    Johnson, Diana; Snedeker, Kristie; Swoboda, Michael; Zalieckas, Cheryl; Dorsey, Rachel; Nohe, Cassandra; Smith, Paige; Roche, Renuka

    The Department of Rehabilitation Services, within the University of Maryland Medical Center's 650-bed academic medical center, was experiencing difficulty in meeting productivity standards. Therapists in the outpatient division believed they were not spending enough time performing billable patient care activities. Therapists in the inpatient division had difficulty keeping pace with the volume of incoming referrals. Collectively, these issues caused dissatisfaction among referral sources and frustration among the staff within the rehabilitation department. The department undertook a phased approach to address these issues that included examining the evidence, using Lean process improvement principles, and employing transformational leadership strategies to drive improvements in productivity and efficiency. The lessons learned support the importance of having meaningful metrics appropriate for the patient population served, the use of Lean as an effective tool for improving productivity in rehabilitation departments, the impact of engaging staff at the grassroots level, and the importance of having commitment from leaders. The study findings have implications for not only rehabilitation and hospital leadership, but CEOs and managers of any business who need to eliminate waste or increase staff productivity.

  16. Program evaluation of remote heart failure monitoring: healthcare utilization analysis in a rural regional medical center.

    Science.gov (United States)

    Riley, William T; Keberlein, Pamela; Sorenson, Gigi; Mohler, Sailor; Tye, Blake; Ramirez, A Susana; Carroll, Mark

    2015-03-01

    Remote monitoring for heart failure (HF) has had mixed and heterogeneous effects across studies, necessitating further evaluation of remote monitoring systems within specific healthcare systems and their patient populations. "Care Beyond Walls and Wires," a wireless remote monitoring program to facilitate patient and care team co-management of HF patients, served by a rural regional medical center, provided the opportunity to evaluate the effects of this program on healthcare utilization. Fifty HF patients admitted to Flagstaff Medical Center (Flagstaff, AZ) participated in the project. Many of these patients lived in underserved and rural communities, including Native American reservations. Enrolled patients received mobile, broadband-enabled remote monitoring devices. A matched cohort was identified for comparison. HF patients enrolled in this program showed substantial and statistically significant reductions in healthcare utilization during the 6 months following enrollment, and these reductions were significantly greater compared with those who declined to participate but not when compared with a matched cohort. The findings from this project indicate that a remote HF monitoring program can be successfully implemented in a rural, underserved area. Reductions in healthcare utilization were observed among program participants, but reductions were also observed among a matched cohort, illustrating the need for rigorous assessment of the effects of HF remote monitoring programs in healthcare systems.

  17. Primary care compensation at an academic medical center: a model for the mixed-payer environment.

    Science.gov (United States)

    Sussman, A J; Fairchild, D G; Coblyn, J; Brennan, T A

    2001-07-01

    The authors' academic medical center, Brigham and Women's Hospital, Boston, Massachusetts, developed a primary care physician (PCP) salary incentive program for employed academic physicians. This program, first implemented in 1999, was needed to meet the financial imperatives placed on the institution by managed care and the Balanced Budget Act of 1997; its goal was to create a set of incentives for PCPs that is consistent with the mission of the academic center and helps motivate and reward PCP's work. The program sought to simultaneously increase productivity while optimizing resource utilization in a mixed-payer environment. The salary incentive program uses work relative-value units (wRVUs) as the measure of productivity. In addition to productivity-derived base pay, bonus incentives are added for efficient medical management, quality of care, teaching, and seniority. The authors report that there was significant concern from several members of the physician staff before the plan was implemented; they felt that the institution's PCPs were already operating at maximum clinical capacity. However, after the first year of operation of this plan, there was an overall 20% increase in PCP productivity. Increases were observed in all PCP subgroups when stratified by professional experience, clinical time commitment, and practice location. The authors conclude that the program has succeeded in giving incentives for academic PCPs to achieve under the growing demands for revenue self-sufficiency, managed care performance, quality of care, and academic commitment.

  18. Burns at the soroka university medical center - a two-year experience.

    Science.gov (United States)

    Gurfinkel, R; Cohen, A D; Glezinger, R; Krieger, Y; Yancolevich, N; Rosenberg, L

    2007-03-31

    Background. Burn trauma is a major public health concern, with increased risk for burns in children. Objectives. To characterize the profile of injured burn patients and to identify patients who are prone to burn injury. Methods. This is a cross-sectional study including all patients who were admitted to the Burns and Plastic Surgery Department, Soroka University Medical Center, Israel, between 1 January 2001 and 31 December 2002. Results. Five hundred and fifty-eight patients with a mean age of 15.4 yr (SD, 19.5 yr) were included in the study. There were 348 male patients (62.4%). The cause of the burns was scalding in 314 patients (56.3%), flame in 177 (31.7%), chemicals in 31 (5.6%), explosion in 20 (3.6%), and electricity in four (0.7%). There were 325 Bedouin patients (58.2%) and 221 Jewish patients (39.6%). In Bedouins, 235 patients (72.3%) were children below 5 yr, compared to 59 Jewish patients (26.7%) (p Soroka University Medical Center are described. Burn injury has become a principal public health problem, particularly in Bedouin children.

  19. 38 CFR 17.37 - Enrollment not required-provision of hospital and outpatient care to veterans.

    Science.gov (United States)

    2010-07-01

    ... provided for in the 'medical benefits package' based on factors other than veteran status (e.g., a veteran..., seeing-eye or guide dogs, sexual trauma counseling and treatment, special registry examinations). (j) A...

  20. Using Learner-Centered, Simulation-Based Training to Improve Medical Students’ Procedural Skills

    Directory of Open Access Journals (Sweden)

    Serkan Toy

    2017-03-01

    Full Text Available Purpose: To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion. Method: The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students’ procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively. Results: In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient ( P < .001. Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t (23 = −2.92, P < .001, and arterial line placement, t (23 = −2.75, P < .001. Procedural performance scores for intubation ( t (23 = −17.29, P < .001, arterial line placement ( t (23 = −19.75, P < .001, lumbar puncture ( t (23 = −16.27, P < .001, and central line placement ( t (23 = −17.25, P < .001 showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures. Conclusions: The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students’ written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.

  1. Meningitis and Meningoencephalitis among Israel Defense Force Soldiers: 20 Years Experience at the Hadassah Medical Centers.

    Science.gov (United States)

    Pikkel, Yoav Y; Ben-Hur, Tamir; Eliahou, Ruth; Honig, Asaf

    2015-11-01

    Meningitis and meningoencephalitis pose major risks of morbidity and mortality. To describe 20 years of experience treating infections of the central nervous system in Israel Defense Force (IDF) soldiers, including the common presentations, pathogens and sequelae, and to identify risk groups among soldiers. All soldiers who were admitted to the Hadassah University Medical Center (both campuses: Ein Kerem and Mt. Scopus) due to meningitis and meningoencephalitis from January 1993 to January 2014 were included in this retrospective study. Clinical, laboratory and radiologic data were reviewed from their hospital and army medical corps files. Attention was given to patients' military job description, i.e., combat vs. non-combat soldier, soldiers in training, and medical personnel. We identified 97 cases of suspected meningitis or meningoencephalitis. Six were mistakenly filed and these patients were found to have other disorders. Four soldiers were diagnosed with epidural abscess and five with meningitis due to non-infectious in flammatory diseases. Eighty-two soldiers in active and reserve duty had infectious meningitis or meningoencephalitis. Of these, 46 (56.1%) were combat soldiers and 31 (37.8%) non-combat; 20 (29.2%) were soldiers in training, 10 (12.2%) were training staff and 8 (9.8%) were medical staff. The main pathogens were enteroviruses, Epstein-Barr virus an d Neisseria meningitidis. In our series, soldiers in training, combat soldiers and medical personnel had meningitis and meningoencephalitis more than other soldiers. Enteroviruses are highly infectious pathogens and can cause outbreaks. N. meningitidis among IDF soldiers is still a concern. Early and aggressive treatment with steroids should be considered especially in robust meningoencephalitis cases.

  2. [Soroka University Medical Center marks its 50th anniversary--a celebration for Israel's health services].

    Science.gov (United States)

    Sofer, Shaul

    2010-03-01

    In December 2009, the Soroka University Medical Center celebrated its 50th anniversary. Following a difficult struggle, Soroka was established in 1959 as a small community hospital. Today, it is difficult to imagine the health services in Israel without a major hospital in the Negev. Soroka is presently providing quality primary, secondary and tertiary medical care to a diverse population of one million people from Kiryat Gat to Eilat. Soroka is the second largest hospital in Israel with over 200,000 emergency visits, 90,000 admissions, 32,000 surgeries and a birth rate of over 13,000 annually. in 1974, the Ben-Gurion University Medical School was opened adjacent to the hospital, with the vision and mission of training humane and skilled physicians and pursuing advanced medical education and research. Within the faculty's framework and the infrastructure of Soroka, the largest Department of Family Physicians in Israel was developed in the Negev. Graduates serve in most of the Negev clinics and have had a tremendous impact on health in the Negev. Many of the graduates are currently serving in key positions in Israel's health services. A third of the School's graduates are annually accepted for training at Soroka. This special edition includes 11 articles representing the clinical research carried out in the hospital's various divisions. They all expose clinical implications of general medical science and some are related to special health problems in the Negev with its diverse population--old native and new immigrants, Jews and Arab Bedouin.We salute Soroka on its outstanding achievements.

  3. CAPITAL STRUCTURE ANALYSIS OF THE MEDICAL DIAGNOSTIC-CONSULTATIVE CENTERS IN VARNA (absolute indicators

    Directory of Open Access Journals (Sweden)

    Lyubomira Koeva-Dimitrova

    2016-08-01

    Full Text Available The capital structure analysis of medical institutions is related to the assessment of their financial sustainability. The degree of their financial sustainability indicates the extent to which the medical institution is exposed to financial risk. This financial risk is related to the use of foreign capital (debts, loans, etc. and it is defined as the probability of insolvency and possible bankruptcy due to the existence of debts which could not be repaid at some point in the foreseeable future. Objective: To analyze the capital structure of the medical diagnostic-consultative centers in Varna city and on this basis to assess their long-term solvency and existence of financial risk. Materials and Methods: The materials for the study are the published annual financial statements (up to 05. 01. 2016 in the Commercial Register for the period from year 2008 to 2014 of all MDCCs (Medical Diagnostic Consultative centers, registered in Varna - 9 in total. In the study are applied logical-mathematical methods (comparison, grouping, detail, graphical method; financial and accounting analysis (balance sheet analysis; analysis of absolute ratios for financial sustainability. Results: Upon analysis of the capital structure of MDCC's are studied the main absolute indicators characterizing the conditions for financial sustainability and the existence of financial risk regarding the solvency. A table represents the overall assessment of the degree of financial sustainability of the companies according to the type and structure of the fulfilled criteria. It was ascertained that for year 2014, DCC 3, 4, 5 and 8 have met all the conditions and according to them these hospitals have very high financial sustainability. DCC 7 has an average financial sustainability, DCC 1 and 2 are in a financial crisis and DCC 6 and 9 are facing bankruptcy. It must be emphasized that nearly half of the studied health care organizations (DCC 1, 2, 6 and 9 need urgent intervention by

  4. A journey through meaningful use at a large academic medical center: lessons of leadership, administration, and technical implementation.

    Science.gov (United States)

    Unger, Melissa D; Aldrich, Alison M; Hefner, Jennifer L; Rizer, Milisa K

    2014-01-01

    Successfully reporting meaningful use of electronic health records to the Centers for Medicare and Medicaid Services can be a challenging process, particularly for healthcare organizations with large numbers of eligible professionals. This case report describes a successful meaningful use attestation process undertaken at a major academic medical center. It identifies best practices in the areas of leadership, administration, communication, ongoing support, and technological implementation.

  5. The first private-hospital based proton therapy center in Korea; status of the Proton Therapy Center at Samsung Medical Center.

    Science.gov (United States)

    Chung, Kwangzoo; Han, Youngyih; Kim, Jinsung; Ahn, Sung Hwan; Ju, Sang Gyu; Jung, Sang Hoon; Chung, Yoonsun; Cho, Sungkoo; Jo, Kwanghyun; Shin, Eun Hyuk; Hong, Chae-Seon; Shin, Jung Suk; Park, Seyjoon; Kim, Dae-Hyun; Kim, Hye Young; Lee, Boram; Shibagaki, Gantaro; Nonaka, Hideki; Sasai, Kenzo; Koyabu, Yukio; Choi, Changhoon; Huh, Seung Jae; Ahn, Yong Chan; Pyo, Hong Ryull; Lim, Do Hoon; Park, Hee Chul; Park, Won; Oh, Dong Ryul; Noh, Jae Myung; Yu, Jeong Il; Song, Sanghyuk; Lee, Ji Eun; Lee, Bomi; Choi, Doo Ho

    2015-12-01

    The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.

  6. The first private-hospital based proton therapy center in Korea; Status of the proton therapy center at Samsung Medical Center

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Kwang Zoo; Han, Young Yih; Kim, Jin Sung [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); and others

    2015-12-15

    The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.

  7. Isoniazid Toxicity among an Older Veteran Population: A Retrospective Cohort Study.

    Science.gov (United States)

    Vinnard, Christopher; Gopal, Anand; Linkin, Darren R; Maslow, Joel

    2013-01-01

    our objective was to determine the incidence of toxicity among veterans initiating isoniazid therapy for latent tuberculosis infection (LTBI) and determine whether advancing age was a risk factor for toxicity. we performed a retrospective cohort study among all adults initiating isoniazid treatment for LTBI at a Veterans Medical Center from 1999 to 2005. We collected data on patient demographics, co-morbidities, site of initiation, and treatment outcome. 219 patients initiated isoniazid therapy for LTBI during the period of observation, and the completion of therapy was confirmed in 100 patients (46%). Among 18/219 patients (8%) that discontinued therapy due to a documented suspected toxicity, the median time to onset was 3 months (IQR 1-5 months). In an adjusted Cox regression model, there was no association between discontinuation due to suspected toxicity and advancing age (HR 1.03, 95% CI 0.99, 1.07). In contrast, hepatitis C infection was a significant predictor of cessation due to toxicity in the adjusted analysis (HR 3.03, 95% CI 1.08, 8.52). cessation of isoniazid therapy due to suspected toxicity was infrequently observed among a veteran population and was not associated with advancing age. Alternative LTBI treatment approaches should be further examined in the veteran population.

  8. Isoniazid Toxicity among an Older Veteran Population: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Christopher Vinnard

    2013-01-01

    Full Text Available Background: our objective was to determine the incidence of toxicity among veterans initiating isoniazid therapy for latent tuberculosis infection (LTBI and determine whether advancing age was a risk factor for toxicity. Methods: we performed a retrospective cohort study among all adults initiating isoniazid treatment for LTBI at a Veterans Medical Center from 1999 to 2005. We collected data on patient demographics, co-morbidities, site of initiation, and treatment outcome. Results: 219 patients initiated isoniazid therapy for LTBI during the period of observation, and the completion of therapy was confirmed in 100 patients (46%. Among 18/219 patients (8% that discontinued therapy due to a documented suspected toxicity, the median time to onset was 3 months (IQR 1–5 months. In an adjusted Cox regression model, there was no association between discontinuation due to suspected toxicity and advancing age (HR 1.03, 95% CI 0.99, 1.07. In contrast, hepatitis C infection was a significant predictor of cessation due to toxicity in the adjusted analysis (HR 3.03, 95% CI 1.08, 8.52. Conclusions: cessation of isoniazid therapy due to suspected toxicity was infrequently observed among a veteran population and was not associated with advancing age. Alternative LTBI treatment approaches should be further examined in the veteran population.

  9. Use of VA and Medicare services by dually eligible veterans with psychiatric problems.

    Science.gov (United States)

    Carey, Kathleen; Montez-Rath, Maria E; Rosen, Amy K; Christiansen, Cindy L; Loveland, Susan; Ettner, Susan L

    2008-08-01

    To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders. Primary VA data sources were the Patient Treatment (acute care), Extended Care (long-term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider-of-Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data. We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one- and two-part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs. Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare-certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures. As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans.

  10. Partnership to improve quality care for veterans: the VA Nursing Academy.

    Science.gov (United States)

    Harper, Doreen C; Selleck, Cynthia S; Eagerton, Gregory; Froelich, Kimberly

    2015-01-01

    More than 22 million living veterans reside in the United States. In fact, understanding military culture and the experiences of these veterans is important to their ongoing health care and the unique challenges faced by many. The Veterans Affairs (VA) Nursing Academy began in 2007 to fund pilot partnerships between schools of nursing and local VA health care facilities to better serve our veteran population. Fifteen academic/service partnerships were selected for funding between 2007 and 2009 with the goals of expanding faculty and professional development, increasing nursing student enrollment, providing opportunities for educational and practice innovations, and increasing the recruitment and retention of VA nurses. This article details critical components of the partnership developed between the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing, a VA Nursing Academy partnership funded in the 2009 cohort. Site-specific goals of the partnership are described along with a discussion of the framework used to develop the Birmingham VA Nursing Academy, which includes relationship building, engagement, governance, evaluation of outcomes, and sustainability. The logic model developed for the partnership is included, and the interim outputs and outcomes of this practice-academic partnership are detailed, a number of which can be replicated by VAs and schools of nursing across the country. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers.

    Science.gov (United States)

    Varela, J Esteban; Nguyen, Ninh T

    2015-01-01

    Analysis of a recent single state bariatric surgery registry revealed that laparoscopic sleeve gastrectomy was the most common bariatric procedure starting in 2012. The objective of this study was to examine the trend in utilization of laparoscopic sleeve gastrectomy performed at academic medical centers in the United States. Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedures performed for the treatment of severe obesity between October 1, 2011, and June 30, 2014. Quarterly trends in utilization for the 4 most commonly performed bariatric operations were examined, and comparisons between procedures were performed. A total of 54,953 bariatric procedures were performed. Utilization of laparoscopic sleeve gastrectomy increased from 23.7% of all bariatric procedures during the fourth quarter of 2011 to 60.7% during the second quarter of 2014 while laparoscopic gastric bypass decreased from 62.2% to 37.0%, respectively. Utilization of laparoscopic sleeve gastrectomy surpassed that of laparoscopic gastric bypass in the second quarter of 2013 (50.6% versus 45.8%). During the same time period, utilization of open gastric bypass fell from 6.6% to 1.5%, and the use of laparoscopic adjustable gastric banding decreased from 7.5% to .8%. Within the context of U.S. academic medical centers, there has been a significant increase in the utilization of laparoscopic sleeve gastrectomy, which has surpassed laparoscopic gastric bypass utilization since 2013. Laparoscopic sleeve gastrectomy is now the most commonly performed bariatric procedure at the national level within academic centers. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Foot care education and self management behaviors in diverse veterans with diabetes

    Directory of Open Access Journals (Sweden)

    Jonathan M Olson

    2009-01-01

    Full Text Available Jonathan M Olson1, Molly T Hogan2, Leonard M Pogach3, Mangala Rajan3, Gregory J Raugi4, Gayle E Reiber51University of Washington School of Medicine, Seattle, WA, USA; 2Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; 3Department of Veterans Affairs, New Jersey Healthcare System, Center for Healthcare Knowledge Management, East Orange, NJ, USA; 4Division of Dermatology, VA Puget Sound Healthcare System, Department of Veterans Affairs, Seattle, WA, USA; 5Research and Development, VA Puget Sound Healthcare System, Department of Veterans Affairs, Seattle, WA, USAAbstract: The objective of this study was to examine differences in self-reported diabetes foot care education, self management behaviors, and barriers to good foot care among veterans with diabetes by race and ethnicity. Data was collected using the Veterans Health Administration Footcare Survey, a validated tool that assessed demographic, general health, diabetes and foot self-care information, barriers to foot self-care, receipt of professional foot care, and satisfaction with current care. We mailed surveys to a random sample of patients with diabetes from eight VA medical centers. Study participants were 81% White; 13% African American; 4% Asian, and 2% American Indian and Pacific Islanders. The majority of respondents felt that they did not know enough about foot self-care. There were large gaps between self-reported knowledge and actual foot care practices, even among those who reported “knowing enough” on a given topic. There were significant differences in self-reported foot care behaviors and education by race and ethnicity. These findings document the need for culturally-specific self-management education to address unique cultural preferences and barriers to care.Keywords: diabetes mellitus, diabetic foot, patient self-management, ethnic groups, education

  13. Epidemiological, Clinical and Paraclinical Study of Hydatid Cysts in Three Educational Medical Centers in 10 Years

    Directory of Open Access Journals (Sweden)

    Simindokht Shoaee

    2016-01-01

    Full Text Available Background: Echinococcosis or hydatidosis, caused by the larval stage of Echinococcus granulosus (E. granulosus, is an important public health problem in many areas of the world  and  Iran is a country of endemic situation for hydatidosis In the present study, we evaluated epidemiological, complications and clinical characteristics of hydatidosis at three University Medical Centers in Tehran over a 10-year period.Materials and Methods: This is a descriptive cross-sectional study performed in patients with hydatid cysts. Information about age, gender, number of cysts, organ involvement, morbidity and mortality and relapse were collected from medical records of hydatid patients. Paraclinic information such as CT Scan, MRI, ultrasound, complete blood count, pathological diagnosis and complication of disease were collected.Results: Overall, 81 patients, 35 (43.2% male and 46 (56.8% female, who were diagnosed as having hydatid cyst by clinical and radiological findings, with pathologic documentation were studied in three university medical center registries over a 10-year period (2003- 2012 in Tehran. Fourteen patients (17% of cases had complications resulting from this disease. Patients' age ranged from 5 to 86 years, and the peak prevalence of the disease was between 20 and 40 (34% of cases.Conclusion: Iran  is a country of endemic situation for hydatidosis. Prevalence rate of hydatidosis in Iran was reported to be 0.61-2 in 100000 populations. The highest  rate of infection and complications were in patients of 20-40 years age. Clinical examination revealed that abdominal pain was the most common complaint and was present in 51.7% of the cases. Other most common complain were cough, abdominal mass, dyspnea, icterus, chest pain, dyspepsia, back pain and seizure; and it was result of occupying effect of cysts in organs. This is similar with previous studies in Iran

  14. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About ... Live Chat Deaf - Hard of Hearing Contact Us About About the Veterans Crisis Line FAQs ...

  15. 38 CFR 21.6521 - Employment of qualified veterans.

    Science.gov (United States)

    2010-07-01

    ... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational Training and....S.C. 1163(c)) (b) Coordination with the Veterans Service Center. The VR&E Division will inform the...

  16. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Involved Crisis Centers About Be There Show You Care Find Resources Graphic Generator Toolkit Signs of Crisis ... out for help. Bittersweet More Videos from Veterans Health Administration Watch additional videos about getting help. Be ...

  17. The Little Rascals Day Care Center Case: A Perspective on Medical Testimony in a Prominent Public Trial.

    Science.gov (United States)

    Smith, Jean C.; And Others

    1994-01-01

    Three medical examiners involved in the Little Rascals Day Care Center (Edenton, NC) child sexual abuse case discuss their experiences. They were surprised to find themselves in an adversarial position against their peers, and the fact that medical evidence of child sexual abuse is controversial created difficulties that could not be solved in a…

  18. Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Moreira, A.M.M., E-mail: anamariainforme@hotmail.com [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil); Guenther, W.M.R. [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil)

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized

  19. Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches.

    Science.gov (United States)

    Chari, Ramya; O'Hanlon, Claire; Chen, Peggy; Leuschner, Kristin; Nelson, Christopher

    2018-02-01

    The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission. Multi-AMC systems, a model in which multiple AMCs are governed by a single body, pose a particular challenge in balancing unity with the needs of component AMCs, and therefore offer lessons for designing AMC governance approaches. This article describes the development and application of a set of criteria to evaluate governance options for one multi-AMC system-the University of California (UC) and its five AMCs. Based on a literature review and key informant interviews, the authors identified criteria for evaluating governance approaches (structures and processes), assessed current governance approaches using the criteria, identified alternative governance options, and assessed each option using the identified criteria. The assessment aided UC in streamlining governance operations to enhance their ability to respond efficiently to change and to act collectively. Although designed for UC and a multi-AMC model, the criteria may provide a systematic way for any AMC to assess the strengths and weaknesses of its governance approaches.

  20. The cost of medical dictation transcription at an academic family practice center.

    Science.gov (United States)

    Lawler, F H; Scheid, D C; Viviani, N J

    1998-01-01

    Very little is known about the volume or cost of medical transcription in primary care. A study of the number of lines and cost of transcription at an academic family practice center was performed to establish the average number of lines and costs of transcription by level of service and type of provider (faculty physician, physician assistant, resident physician, and others). Parallel 4-month sets of computerized billing records and computerized transcription summary logs (listing the patient name and identification, the dictator, the number of lines of dictation, and the date for each dictation) were merged and analyzed to compare the cost and volume of dictation by types of service and types of provider. During the study period there were 11,085 patient encounters, 9013 with transcription. The average cost of transcription per encounter using transcription was $3.96 and the median was $3.64. The cost per encounter ranged from $0.39 (3 lines of dictation) to $24.83 (191 lines of dictation). Faculty physicians and physician assistants had the lowest cost, resident physicians were intermediate in cost, and others (such as medical students) had the highest costs for medical transcription. Transcription costs rose with increasing level of service but became a smaller proportion of the collected fee, averaging only 5% for a level 5 encounter. The cost of transcription as a part of overhead was higher than anticipated. Specific education regarding dictation form and content and ways to decrease these costs is appropriate.

  1. Analysis of medical prescriptions dispensed at health centers in Belo Horizonte, Minas Gerais, Brazil

    Directory of Open Access Journals (Sweden)

    Acurcio Francisco A.

    2004-01-01

    Full Text Available This article focuses on medical prescriptions dispensed at health centers under the Municipal Health Department in Belo Horizonte, Minas Gerais State, Brazil. The study analyzed 4,607 prescriptions from March to April 1999, grouped according to origin (internal or external. The analysis focused on information written on medical prescriptions. The main findings were: (a an average of 2.4 drugs per prescription in both groups; (b prescriptions filled out with 4 or more drugs accounted for 18.0% of internal and 17.6% of external prescriptions; (c 84.3% of internal and 85.5% of external prescriptions provided no instructions for use of medication; (d information on dosage regimen varied from 51.2% to 97.6% for internal and 57.9% to 96.5% for external prescriptions; (e generic names were specified for 51.9% and 28.4% of all drugs on internal and external prescriptions, respectively; (f prescriptions containing standard drugs from the Municipal Health Department accounted for 88.7% of internal and 76.4% of external prescriptions. Data analysis shows the need for continuing education of physicians and adoption of other methods to improve quality of prescriptions and promote rational use of drugs.

  2. Citations in Life Science Patents to Publicly Funded Research at Academic Medical Centers.

    Science.gov (United States)

    Sampat, Bhaven N; Pincus, Harold Alan

    2015-12-01

    The contributions of Academic Medical Centers (AMCs) to biomedical innovation have been difficult to measure because of the challenges involved in tracing knowledge flows from their origin to their uses. The authors examined patent citation linkages between AMC research funded by the National Institutes of Health (NIH) and patents. In prospective analyses, they examine the extent to which articles resulting from NIH grants to AMCs awarded between 1990 and 1995 were cited in drug and medical patents. The authors then examine the extent to which these patents are associated with marketed drugs. In retrospective analyses, they examine the share of drugs approved between 2000 and 2009 that have citation links to NIH-funded AMC research. The prospective analyses show over a third of AMC grants resulted in publications that were cited in patents. Most the patents are drug and biotechnology patents, and are assigned to private firms. Patents citing NIH-funded AMC publications were associated with 106 new FDA approved drugs, half of which are new molecular entities and a quarter of which are priority NMEs. The retrospective analyses showed that about half of the new molecular entities approved over the 2000-2009 period had citations links to NIH-funded AMC research. There are strong links between articles from NIH-funded AMC research and private sector medical patenting, including drugs. More research is needed to better understand the types of links the citations represent and their implications for public policy. © 2015 Wiley Periodicals, Inc.

  3. ANALISIS TINGKAT KEPUASAN PELANGGAN POLI UMUM DI MAJAPAHIT MEDICAL CENTER (MMC LAMONGAN

    Directory of Open Access Journals (Sweden)

    Gurendro Putro

    2012-09-01

    Full Text Available Costumer satisfaction is one of the costumer loyaiity factors. After seeing health-service-data in MMC Lamongan shows that general polyclinic has tendency for decreasing visitors about -165 from 2003 until 2006. From those data, need to do research about satisfaction of health service in general polyclinic MMC Lamongan. Design research has cross sectional observation characteristic by use satisfaction theory from Dabholkar that's composed offive points, there are physical aspect, reliability, personal interaction, problem solving, and policy. The research's result shows that costumer satisfaction of medical service has strong value in physical aspect and problem solving. In the other hand, costumer satisfaction in supporting-and-non-supporting medical service has strong value in personal interaction. All customers have loyaiity in MMC Lamongan's service. The conclusion shows customer satisfaction is one of the important aspect for increase health service quality, so it's expected costumer always use meritorious service given by MMC Lamongan.   Keywords : satisfaction, general polyclinic, majapahit medical center

  4. Optimal scheduling of logistical support for medical resources order and shipment in community health service centers

    Directory of Open Access Journals (Sweden)

    Ming Liu

    2015-11-01

    Full Text Available Purpose: This paper aims to propose an optimal scheduling for medical resources order and shipment in community health service centers (CHSCs.Design/methodology/approach: This paper presents two logistical support models for scheduling medical resources in CHSCs. The first model is a deterministic planning model (DM, which systematically considers the demands for various kinds of medical resources, the lead time of supplier, the storage capacity and other constraints, as well as the integrated shipment planning in the dimensions of time and space. The problem is a multi-commodities flow problem and is formulated as a mixed 0-1 integer programming model. Considering the demand for medical resources is always stochastic in practice, the second model is constructed as a stochastic programming model (SM. A solution procedure is developed to solve the proposed two models and a simulation-based evaluation method is proposed to compare the performances of the proposed models. Findings andFindings: The main contributions of this paper includes the following two aspects: (1 While most research on medical resources optimization studies a static problem taking no consideration of the time evolution and especially the dynamic demand for such resources, the proposed models in our paper integrate time-space network technique, which can find the optimal scheduling of logistical support for medical resources order and shipment in CHSCs effectively. (2 The logistics plans in response to the deterministic demand and the time-varying demand are constructed as 0-1 mixed integer programming model and stochastic integer programming model, respectively. The optimal solutions not only minimize the operation cost of the logistics system, but also can improve the order and shipment operation in practice.Originality/value: Currently, medical resources in CHSCs are purchased by telephone or e-mail. The important parameters in decision making, i.e. order/shipment frequency

  5. Hospital utilization and personality characteristics of veterans with psychiatric problems.

    Science.gov (United States)

    Williams, W; Weiss, T W; Edens, A; Johnson, M; Thornby, J I

    1998-03-01

    The relationship between hospital utilization and psychometric, demographic, and diagnostic data was examined among veterans with psychiatric problems. Data were obtained from the records of 500 psychiatric inpatients admitted to a Veterans Affairs medical center between 1984 and 1987 and followed for four years. All patients completed the Minnesota Multiphasic Personality Inventory, the California Personality Inventory, the Millon Clinical Multiaxial Inventory, and the Psychological Inventory of Personality and Symptoms. Stepwise linear regression analysis was used to predict the number and length of inpatient stays, and Cox and logistic regression analyses predicted rehospitalization. Higher rates of psychiatric hospital utilization were found among patients who were unmarried, who had disabilities connected with their military service, who had lower levels of adaptive functioning, and who were diagnosed as having posttraumatic stress disorder, drug or alcohol use disorder, or passive-aggressive or antisocial personality disorder. Higher utilization was also found among those whom psychometric data characterized as less responsible and more compulsive. The data also predicted the length of subsequent medical hospitalization and identified patients who stayed out of the hospital longer and who were not rehospitalized. Hospital utilization was found to be a function of psychiatric diagnosis, marital status, and various personality factors. Factors relating to social disadvantage also played a role. Axis I diagnoses, particularly substance use disorders, were as important as, if not more important than, axis II diagnoses in predicting utilization.

  6. US veterans and their unique issues: enhancing health care professional awareness

    Directory of Open Access Journals (Sweden)

    Olenick M

    2015-12-01

    Full Text Available Maria Olenick,1 Monica Flowers,1 Valerie J Diaz1,21Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami, FL, USA; 2Operational Health Support Unit Jacksonville, United States Navy Nurse Corps, Jacksonville, FL, USAAbstract: United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies

  7. The Impact of Patient-Centered Medical Homes on Quality of Care and Medication Adherence in Patients with Diabetes Mellitus.

    Science.gov (United States)

    An, JaeJin

    2016-11-01

    Current evidence suggests that patient-centered medical homes (PCMHs) potentially increase overall quality of disease management, including preventive care. However, there are mixed findings regarding quality of diabetes care, and little evidence exists with respect to the effect of PCMHs on medication adherence in patients with diabetes. To investigate associations between PCMHs and process measures of diabetes care, as well as adherence to oral hypoglycemic agents (OHAs) in patients with diabetes in a nationally representative U.S. Using the 2009-2013 longitudinal data files from the Medical Expenditure Panel Survey, adult diabetes patients were identified. Patients whose usual sources of care have all PCMH features at baseline (i.e., enhanced access after hours and online, shared decision making, and enhanced patient engagement) were categorized as the PCMH group, which was compared with patients without PCMH features. Process measures of diabetes care included ≥ 2 hemoglobin A1c tests and ≥ 1 cholesterol test, foot examination, dilated eye examination, and flu vaccination during 1 year of follow-up. Medication possession ratio (MPR) during follow-up was calculated for patients with OHAs without any insulin use, with MPR ≥ 80% considered to be adherent to OHAs. Univariate and multivariate regression models considering sampling strata and weights were used to examine the association between the PCMH and study outcomes. A total of 3,334 patients with diabetes was identified, representing 61 million U.S. lives. The mean (SE) age was 61.6 (0.3) years, and 52.4% of patients were female. The mean (SE) years of having diabetes was 12.0 (0.2) years. Approximately 11.4% of the patients were categorized as the PCMH group at baseline, and only 3.6% of those patients remained in the PCMH group for 2 years. Of the diabetic patients identified, only 26.9% met all of the diabetes care process measure criteria defined in this study. A higher proportion of patients met

  8. A case study of the Materials Management Department at the Naval Medical Center San Diego benchmarking effort

    OpenAIRE

    Boston, Pia S.

    1997-01-01

    Approved for public release; distribution is unlimited This thesis sought to provide lessons learned, recommendations and provoke thought among medical logisticians on the use of benchmarking. The researcher used a single case research strategy to assess how successful the Materials Management Department at the Naval Medical Center San Diego has been in implementing benchmarking as suggested by strategic objective 2.5.43 of the 1994 draft of the Navy Medical Logistics Strategic Plan. Infor...

  9. Integrated Pharmacies at Community Mental Health Centers: Medication Adherence and Outcomes.

    Science.gov (United States)

    Wright, W Abel; Gorman, Jack M; Odorzynski, Melissa; Peterson, Mark J; Clayton, Carol

    2016-11-01

    Patients receiving psychiatric services at community mental health centers (CMHCs) are often prescribed medication that is critical to the treatment of behavioral health conditions, including schizophrenia, bipolar disorder, anxiety, and depression. Previous studies have shown correlation between rates of medication adherence and risk of hospitalization, but potential differences in medication adherence and other outcomes for patients of CMHCs by pharmacy type have not been widely studied. To determine potential benefits of placing a pharmacy within a mental health service delivery setting on both adherence to medication and health outcomes. A retrospective cohort analysis of medication adherence rates, hospital and emergency department (ED) use, and related costs between patients of CMHCs was conducted using integrated pharmacies versus community pharmacies. Data were from Medicaid claims paid by Southwest Michigan Behavioral Health for all (behavioral and nonbehavioral) inpatient and outpatient services as well as pharmacy prescriptions filled from April 1, 2014, through April 30, 2015. The primary study analysis was composed of an adult dataset representing persons served from 1 of the 2 CMHCs who had filled at least 2 prescriptions for a specific medication from 1 of 2 Genoa pharmacies located in a CMHC during the study period. Each unique patient dataset in the treatment group was matched to a corresponding control patient dataset prescribed the same medication using a modified version of the Gale-Shapley algorithm. The primary analysis compared medication possession ratio, which is a measure of adherence that indicates gaps or oversupply in a patient's medication use history. Statistical tests were performed using the R statistical programming language and Microsoft Excel. Patients using pharmacies integrated within the CMHCs had higher medication adherence rates, lower rates of hospitalization, and lower ED use than those filling their prescriptions at

  10. Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation.

    Science.gov (United States)

    Plagge, Jane M; Lu, Mary W; Lovejoy, Travis I; Karl, Andrea I; Dobscha, Steven K

    2013-08-01

    We explore preliminary clinical effectiveness and feasibility of an intervention utilizing collaborative care components and behavioral activation (BA) to treat comorbid chronic pain and posttraumatic stress disorder (PTSD). Descriptive, including pre- and posttreatment assessment results. Portland Veterans Affairs Medical Center. Fifty-eight Iraq and Afghanistan veterans with chronic pain and PTSD symptoms. Veterans participated in a biopsychosocial evaluation and up to eight BA sessions using a collaborative approach involving primary care, mental health, and other clinicians. A physiatrist assisted the psychologist in providing recommendations to primary care providers. Participants were administered pre- and posttreatment measures of PTSD, pain severity, pain interference, mental health, quality of life, satisfaction, and global ratings of change with the purpose of assessing progress and improving quality. Of the 58 participants, 30 completed treatment. Common recommendations included physical therapy and exercise programs, pain medication or pain medication adjustments, and additional diagnostic workups, such as imaging. Participants who completed the program showed significant improvements on measures of PTSD, pain severity, and pain interference. Improvements were also evident on measures of mental health and quality of life. Overall, participants were satisfied with the program, and on average reported feeling "somewhat better." These findings suggest that a collaborative approach that includes BA is feasible and a potentially effective treatment for comorbid chronic pain and PTSD. Wiley Periodicals, Inc.

  11. Impact of Agent Orange Exposure among Korean Vietnam Veterans

    National Research Council Canada - National Science Library

    KIM, Joung-Soon; LIM, Hyun-Sul; CHO, Sung-Il; CHEONG, Hae-Kwan; LIM, Min-Kyung

    2003-01-01

    In order to determine whether Agent Orange exposure was associated with increased frequency of medical problems, we conducted a cross-sectional epidemiologic study of Korean veterans during 1995-1996...

  12. 78 FR 42455 - Medications Prescribed by Non-VA Providers

    Science.gov (United States)

    2013-07-16

    ... programs or the rights and obligations of recipients thereof; or (4) Raise novel legal or policy issues....009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental Care... Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64.018, Sharing Specialized Medical Resources; 64...

  13. The effect of work shift configurations on emergency medical dispatch center response.

    Science.gov (United States)

    Montassier, Emmanuel; Labady, Julien; Andre, Antoine; Potel, Gilles; Berthier, Frederic; Jenvrin, Joel; Penverne, Yann

    2015-01-01

    It has been proved that emergency medical dispatch centers (EMDC) save lives by promoting an appropriate allocation of emergency medical service resources. Indeed, optimal dispatcher call duration is pivotal to reduce the time gap between the time a call is placed and the delivery of medical care. However, little is known about the impact of work shift configurations (i.e., work shift duration and work shift rotation throughout the day) and dispatcher call duration. Thus, the objective of our study was to assess the effect of work shift configurations on dispatcher call duration. During a 1-year study period, we analyzed the dispatcher call durations for medical and trauma calls during the 4 different work shift rotations (day, morning, evening, and night) and during the 10-hour work shift of each dispatcher in the EMDC of Nantes. We extracted dispatcher call durations from our advanced telephone system, configured with CC Pulse + (Genesys, Alcatel Lucent), and collected them in a custom designed database (Excel, Microsoft). Afterward, we analyzed these data using linear mixed effects models. During the study period, our EMDC received 408,077 calls. Globally, the mean dispatcher call duration was 107 ± 45 seconds. Based on multivariate linear mixed effects models, the dispatcher call duration was affected by night work shift and work shift duration greater than 8 hours, increasing it by about 10 ± 1 seconds and 4 ± 1 seconds, respectively (both p work shift rotation and duration, with longer durations seen over night shifts and shifts over 8 hours. While these differences are small and may not have clinical significance, they may have implications for EMDC efficiency.

  14. [Work satisfaction, quality of life and leisure time of residents at the Soroka University Medical Center, Beer Sheba, Israel].

    Science.gov (United States)

    Acker, Asaf; Perry, Zvi; Reuveni, Haim; Toker, Asaf

    2009-02-01

    Work dissatisfaction among physicians worldwide continues to rise over the last few decades, mainly due to declining professional prestige, tack of self fulfillment, time pressure and tack of leisure time. Physicians' burnout is a major result of dissatisfaction, causing doctors to leave the medical profession, and to provide lower quality of care. To examine the work satisfaction, quality of life and leisure time of residents in the Soroka University Medical Center. A validated questionnaire was delivered during the second half of 2004 to 252 residents in the Soroka University Medical Center The data was analyzed using the SPSS 12 for windows program. Descriptive analysis, parametric Students' T Test [where pSoroka University Medical Center were satisfied with their work environment but not with their quality of life and leisure time. Further attention must be given to these matters--a step which will eventually improve patient care, and delay, to some extent, the burnout of physicians.

  15. Perspectives on Sexual Health and Function of Recent Male Combat Veterans of Iraq and Afghanistan.

    Science.gov (United States)

    Helmer, Drew A; Beaulieu, Gregory; Powers, Catherine; Houlette, Cheryl; Latini, David; Kauth, Michael

    2015-09-01

    U.S. veterans of recent wars in Iraq and Afghanistan may be at greater risk for sexual dysfunction due to injuries, mental health conditions, medications used to treat those conditions, and psychosocial factors. To explore the perceptions of recent Veterans about sexual health and dysfunction, contributing factors, its impact and solutions. Qualitative study. Eight men who screened positive for sexual dysfunction at initial presentation to a postdeployment clinic at a Veterans Affairs medical center. Patients who screened positive for sexual dysfunction and indicated an interest in participating were contacted and scheduled for an in-person private interview with a researcher. Interviews were semistructured, utilizing open-ended and follow-up probe questions to elicit the individual's perspective about sexual dysfunction and its cause, impact and solutions. Interviews were recorded, transcribed and analyzed for themes. These heterosexual men discussed a range of sexual dysfunction in their activities including lack of desire, erectile dysfunction, delayed orgasm, premature ejaculation, and distraction. They also discussed the importance of setting or context and changes over time to their sexual health and function. The men shared their ideas about contributory factors, including normal aging, medication side effects, injury and a possible role for combat deployment more generally. Reported solutions for sexual dysfunction included medications, herbal remedies, and new positions and approaches to sexual activity. Participants reported discussing sexual dysfunction with their health-care providers and what was helpful. Finally, the men expressed in their own words the significant impact of sexual dysfunction on their self-perception, their partners, and their relationships. Sexual dysfunction in recent combat veterans can have important negative effects on their health and relationships. Our findings elucidate perceived contributory factors and preferred solutions

  16. Lumbar Spine Surgeries and Medication Usage During Hospital Stay: One-Center Perspective.

    Science.gov (United States)

    Sharma, Neena K; Olotu, Busuyi; Mathew, Asha; Waitman, Lemuel R; Rasu, Rafia

    2017-12-01

    Background: Pain after spine surgery is usually managed with opioid and nonopioids. The rate of lumbar spine surgeries (LSS) is rising, but current practices on LSS are not known. A current trend in LSS and medication usage by age group is needed to gain a better understanding of how LSS and its pain management vary by age. Objective: The aim of this study was to report current practices of LSS of discectomy, laminectomy, and fusion in patients aged 18 and older and to gain an understanding of medication use for management of LSS. Methods: This retrospective study analyzed data of the University of Kansas Medical Center from 2007 to 2014 of patients (>18 years of age) undergoing laminectomy, discectomy, and fusion. Results: A total of 19 463 patients underwent LSS between 2007 and 2014 at Kansas University hospital. For the purpose of this study, 3115 patients' medical records were observed. A 50% increase in LSS between 2007 and 2014 was noted. Specifically, more than 2-fold increase in LSS was observed in patients aged 65 years and older. Among those aged 65 years and older, laminectomy was the most commonly performed surgery (69.6%) while discectomy was the most common surgery performed among those aged 18 to 34 (82.9%) and those aged 35 to 44 (72%). The medication use also increased with a highest usage in opioids alone (55%), followed by opioids combined with other analgesics (42.7%), regardless of lumbar surgery type or age. Conclusion: The information of increase in both LSS and the medication usage over the 7 years can be used to gain a better understanding of quality, expenditure, and outcomes following LSS. This knowledge may help health care providers plan patient care and rehabilitation services for older adults, as the trajectory of lumbar spine surgery is likely to rise with growing prevalence of older adults. The information regarding increased opioid utilization may also help clinicians to refine opioid usage and consider alternative approaches to

  17. The role of the pharmacist in patient-centered medical home practices: current perspectives

    Directory of Open Access Journals (Sweden)

    Lewis NJW

    2014-06-01

    Full Text Available Nancy JW Lewis,1 Leslie A Shimp,2 Stuart Rockafellow,2 Jeffrey M Tingen,2 Hae Mi Choe,3 Marie A Marcelino21Private consultancy practice, Rochester Hills, MI, USA; 2Clinical, Social and Administrative Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 3Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Patient-centered medical homes (PCMHs are the centerpiece of primary care transformation in the US. They are intended to improve care coordination and communication, enhance health care quality and patient experiences, and lower health care costs by linking patients to a physician-led interdisciplinary health care team. PCMHs are widely supported by health care associations, payers, and employers. Health care accreditation organizations have created performance measures that promote the adoption of PCMH core attributes. Public and private payers are increasingly providing incentives and bonuses related to performance measure status. Evidence-based prescription, medication adherence, medication use coordination, and systems to support medication safety are all necessary components of PCMHs. Pharmacists have unique knowledge and skills that can complement the care provided by other PCMH team members. Their experience in drug therapy assessments, medication therapy management, and population health has documented benefits, both in terms of patient health outcomes and health care costs. Through collaborative care, pharmacists can assist physicians and other prescribers in medication management and thus improve prescriber productivity and patient access to care. Pharmacists are engaged in PCMHs through both employment and contractual arrangements. While some pharmacists serve a unique PCMH, others work within practice networks that serve practices within a geographical area. Financial support for pharmacist-provided services includes university funding, external grant funding

  18. Health-related quality of life among individuals with long-standing spinal cord injury: a